Osteoanabolic therapy for osteoporosis in women

Climacteric. 2022 Feb;25(1):60-66. doi: 10.1080/13697137.2021.1953463. Epub 2021 Aug 3.


Therapy to activate bone formation is required to reverse and restore the damaged bone architecture found in women with postmenopausal osteoporosis. The osteoanabolic drugs include teriparatide, which has been available for several years, and abaloparatide and romosozumab, novel osteoanabolic drugs that have become available more recently. By stimulating bone formation, these drugs produce greater increases in bone mass and bone strength, and they do so more quickly compared to the commonly used anti-remodeling (also called antiresorptive) drugs such as bisphosphonates. In head-to-head trials, teriparatide and romosozumab reduce fracture risk more effectively than do oral bisphosphonates in women with osteoporosis and high fracture risk. Osteoanabolic drugs have little role in the prevention of bone loss during early menopause, but they have an important place in the treatment of women at very high risk of fracture or who remain at high fracture risk after a course of bisphosphonate therapy. Primarily because of the high cost of the drugs, these therapies are initiated by specialists rather than primary-care physicians in most countries. This review will present the evidence for efficacy and safety of these drugs so that clinicians may discern their appropriate use when caring for postmenopausal women with osteoporosis.

Keywords: Osteoanabolic; abaloparatide; osteoporosis; romosozumab; sequence; teriparatide.

Publication types

  • Review

MeSH terms

  • Bone Density
  • Bone Density Conservation Agents* / pharmacology
  • Bone Density Conservation Agents* / therapeutic use
  • Diphosphonates / pharmacology
  • Diphosphonates / therapeutic use
  • Female
  • Fractures, Bone* / prevention & control
  • Humans
  • Osteoporosis* / drug therapy
  • Osteoporosis, Postmenopausal* / drug therapy
  • Teriparatide / therapeutic use


  • Bone Density Conservation Agents
  • Diphosphonates
  • Teriparatide