BISPHOSPHONATES, RANKL INHIBITORS OR ANTI-SCLEROSTIN ANTIBODIES TO TREAT OSTEOPOROSIS?

RANKL inhibitors and anti-sclerostin antibodies (AcSOST) emerge as innovative alternatives for the treatment of osteoporosis. The technological attractiveness resides in their original mechanism of action, which, if applied to certain bone physio-pathologic conceptions, seems to extend its therapeutic promise up to the cure for osteoporosis. Notwithstanding, our current understanding of bone fragility causes is not complete and/or deserves maturation in many aspects, before predicting reliable benefits of a given therapy. Currently, bisphosphonates (BP) are the most accepted treatments for osteoporosis; even through their performance is not comprehensively satisfactory, and their mode of action not fully understood. Nevertheless the actual rate of efficacy has not been beaten in face-to-face testing against newer options; their safety margin is high, and the accessibility quite favorable due to the availability of generic versions. These features make controversial the predictive value of a given mode of action, and derived in clinical advantages and risks, and costs. Finally, RANKL inhibitors and AcSOST as well as BP share some therapeutics duties with bone rare conditions which may better explain the relationship between mechanism-effects but has been neglected, expanding the debate to the field of the researcher's social responsibility. Opening an early debate is always positive to adjust expectancies and for locating each treatment option in its right place within the medical scheme for osteoporosis.