Treatment of osteoporosis with anabolic agents – clinical guidelines and personalized patient assessment
Medical Review (Med. pregled), 2025, 61(4), 5-13.
M. Nedkova1,2, S. Neicheva3
1 Faculty of Medicine, Burgas State University “Prof. Dr. Asen Zlatarov”
2 Department of Rheumatology, UMHAT – Burgas
3 Department of Rheumatology, MMA – Sofia
Abstract. Osteoporosis represents a significant health challenge, particularly among the ageing population worldwide. Over the next 10 years, more than five million people will be affected by osteoporotic fractures in the European Union, including the United Kingdom and Switzerland. The number of patients at very high fracture risk who are correctly diagnosed and treated is limited, indicating the need for a paradigm shift. The first step is to accurately identify patients suitable for anabolic therapies. The approach to defining high-risk groups varies across countries, depending on fracture history, bone mineral density results and the use of validated fracture risk prediction tools. For patients at very high fracture risk, anabolic agents are recommended as first-line therapy followed by antiresorptive agents. Their effective use for the treatment of osteoporosis involves a comprehensive strategy with individualized patient assessment, taking into account cost, effectiveness and the application of the correct sequence of therapies. This approach aims to maximize patient outcomes and healthcare efficiency.
Key words: anabolic agents, osteoporosis, fracture risk, strategy