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Review
. 2020 Jul 20:19:1017-1037.
doi: 10.17179/excli2020-2591. eCollection 2020.

Osteoporosis: Pathophysiology and therapeutic options

Ursula Föger-Samwald  1 , Peter Dovjak  2 , Ursula Azizi-Semrad  3 , Katharina Kerschan-Schindl  4 , Peter Pietschmann  1
Affiliations
Review

Osteoporosis: Pathophysiology and therapeutic options

Ursula Föger-Samwald et al. EXCLI J. .

Abstract

Osteoporosis is a metabolic bone disease that, on a cellular level, results from osteoclastic bone resorption not compensated by osteoblastic bone formation. This causes bones to become weak and fragile, thus increasing the risk of fractures. Traditional pathophysiological concepts of osteoporosis focused on endocrine mechanisms such as estrogen or vitamin D deficiency as well as secondary hyperparathyroidism. However, research over the last decades provided exiting new insights into mechanisms contributing to the onset of osteoporosis, which go far beyond this. Selected mechanisms such as interactions between bone and the immune system, the gut microbiome, and cellular senescence are reviewed in this article. Furthermore, an overview on currently available osteoporosis medications including antiresorptive and bone forming drugs is provided and an outlook on potential future treatment options is given.

Keywords: gut microbiome; osteoimmunology; osteoporosis; osteoporosis treatment; pathophysiology; senescence.

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Figures

Table 1
Table 1. Selected treatment options for osteoporosis mentioned in this review
Table 2
Table 2. Nonpharmacologic treatment
Figure 1
Figure 1. Histological section of a mouse femur; stain: toluidin blue; original magnification: 400X
Figure 2
Figure 2. Overview on pathophysiological mechanisms discussed in this review
Figure 3
Figure 3. Algorithm for the diagnosis and pharmacologic treatment of osteoporosis (adapted from Kanis et al., 2019, Cosman, 2020 and Anastasilakis et al., 2020)
See this image and copyright information in PMC

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