Table 1.

Pharmacologic treatment options for bone health optimization.

Class	Agent	Brand Name	Mechanism of Action
Vitamin and mineral supplements	Calcium	N/A	The main mineral component of bone. Forms calcium salts (mostly calcium phosphate) by osteoblasts which harden cartilaginous bone matrices and thus bone building
	Vitamin D	N/A	Activates intestinal absorption of calcium and maintaining calcium homeostasis
Antiresorptive agents	Bisphosphonates	Reclast, Boniva, Fosamax, Zoneta, Actonel Aclasta	Inhibits osteoclast function, thus allowing osteoblasts to more efficiently build bone mass
Anabolic agents	Denosumab	Prolia	Monoclonal antibody that inhibits receptor activator of nuclear factor kappa-B ligand (RANKL), resulting in decreased osteoclast development
	Romosozumab	Evenity	Monoclonal antibody that binds and inhibits sclerostin, a protein secreted by osteocytes that inhibits osteoblast function increases RANKL which activates osteoclasts (PMID: 30775535). Thus, romosozumab is unique in that it increases bone formation and decreases bone resorption
Parathyroid hormone (PTH) analogs	Teriparatide	Forteo	Regulates calcium and phosphate metabolism in bone and the kidneys. Counterintuitively increases bone resorption, thus resulting in increased serum calcium levels. However, low-dose and intermittent exposure (i.e., once daily) disproportionately activate osteoblasts with increased serum calcium more than osteoclast function, thus having a net effect of increased bone mineral density
	Abaloparatide	Tymlos	Similar to teriparatide, but with different pharmacokinetics that may confer some advantages in bone mineral density improvements