Antiresorptive Drugs’ Role in Management of Postmenopausal Osteoporosis

Postmenopausal osteoporosis is a very common bone metabolic disorder, characterized by low bone mineral density, impairment of bone microarchitecture, and increased fractures risk. The primary cause of body mineral density reduction is the lack of estrogens, especially in 3–5 years after the onset of menopause. Fragility fractures due to postmenopausal osteoporosis are usually associated to significant burden, high healthcare expenses, and increased morbidity. Postmenopausal women at increased risk of fracture are typically chosen as the population for the pivotal studies on antifracture treatment. This chapter focuses on all antiresorptive drugs currently available for pharmacological management of postmenopausal osteoporosis. The most important challenge is to identify women affected by postmenopausal osteoporosis who need to be treated, considering efficacy, risk profile, cost-effectiveness of antiresorptive drugs, and clinical features of patient. However, although significant benefits of antiresorptive drugs have been widely demonstrated, these treatments are frequently under-prescribed also in postmenopausal osteoporosis, issue which should be resolved as much as possible in the next future.