Denosumab in Osteoporosis and Oncology

Bone remodeling throughout life is adelicate balance between bone for-mation and resorption. Multiple factors, including the presence of hormones, growth factors, and cytokines, influence the rate of bone loss. Degradation of bone requires careful attention and ap-propriate treatment. Bisphosphonates are the primary treatment modalities for os-teoporosis and metastatic bone disease; however, this drug class is not without limitations and the long-term effects on bone quality are not yet known. Bisphosphonates effectively reduce fracture rate in patients with osteoporosis, but the strict administration instructions and gastrointestinal adverse effects may discourage adherence and negatively in-fluence the achievable benefit.1 Evalua-tion of 2 databases containing data for more than 35,000 women demonstrated an inverse relationship between adher-ence to bisphosphonate therapy and frac-ture risk after 2 years of therapy.2 More recently, a study of nearly 9000 patients with osteoporosis demonstrated that less than 80 % adherence to the medication regimen resulted in an increase of nearly 50 % in fracture risk compared with pa-tients with greater than 80 % adherence.1 Patients with low adherence rates (<50%) received no benefit. Additional options to treat osteoporosis with fewer adher-ence barriers would be welcomed