The past 30 years have witnessed tremendous progress in our ability to diagnose and treat osteoporosis. Once considered an inevitable consequence of ageing, osteoporosis can now be accurately diagnosed using dual-energy x-ray absorptiometry (DXA). Fundamental advances in the understanding of the pathogenesis of osteoporosis have driven the development of highly effective treatments, including four bisphosphonates (alendronate, risedronate, ibandronate, and zole-dronate), a human monoclonal anti-body to the receptor activator of nuclear factor κB ligand (denosumab), parathyroid hormone/parathyroid hormone-related peptide analogues (teriparatide and abaloparatide), and a humanised monoclonal antibody to sclerostin (romosozumab). Despite these remarkable advances, there are crucial clinical practice and scientific gaps in fracture prevention in the USA.
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