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This chapter describes the existing pharmacological options to reduce fracture risk, documents the emerging considerations regarding their use, and describes novel therapies in development, which will further add to a comprehensive treatment armamentarium. It examines that calcium with concomitant vitamin D supplementation is supported for patients at high risk of calcium and vitamin D deficiency and for those receiving treatment for osteoporosis. Bisphosphonates are synthetic analogues of the naturally occurring compound pyrophosphate and bind strongly to hydroxyapatite, inhibiting bone resorption by inactivating osteoclasts. Denosumab, a fully human antibody to receptor activator of nuclear factor kappa B ligand (RANKL) is a newer antiresorptive agent. RANKL, secreted by osteoblasts, is a major activator of osteoclastic bone resorption. Raloxifene is a selective oestrogen receptor modulator that has antiresorptive oestrogenic effects on the skeleton without the unwanted risks of oestrogen in breast. Sclerostin, an osteocyte-derived glycoprotein that modulates bone formation by osteoblasts, is primarily regulated by mechanical loading; increased load reduces sclerostin secretion.


Mary MacKillop Institute for Health Research

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Book Chapter

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