Understanding the newest injections for osteoporosis
Recent pharmaceutical developments have brought new and effective injectable options to the forefront of osteoporosis management. While Evenity (romosozumab) is often cited as the "newest" type of bone-building injection, significant developments in the biosimilar market have expanded the range of options. For patients at high risk of fracture, these treatments offer new pathways to increase bone density and reduce fracture risk.
Evenity (Romosozumab): A dual-action bone builder
Evenity, with the active ingredient romosozumab, is a monoclonal antibody approved by the FDA in 2019 for postmenopausal women at high risk of fracture. It works by both increasing bone formation and decreasing bone resorption, making it a dual-action therapy. Evenity blocks sclerostin, a protein that inhibits bone creation, thereby stimulating bone-building cells. Its bone-building effect is most pronounced in the first year, leading to a limited 12-month treatment course of monthly injections. Following Evenity, another osteoporosis medication is typically used to maintain bone density. It's often used for severe cases or those who haven't responded to other treatments.
Denosumab biosimilars: Expanding access to treatment
In March 2024, the FDA approved the first interchangeable biosimilars for denosumab (the ingredient in Prolia), named Jubbonti and Wyost. While denosumab itself isn't new, these biosimilar approvals are a recent advancement. Biosimilars are highly similar to their reference product with no significant clinical differences, and interchangeable biosimilars can be substituted by a pharmacist. Like Prolia, Jubbonti is a monoclonal antibody that targets RANKL to prevent bone breakdown, acting as an anti-resorptive therapy. These are typically given every six months. The approval of biosimilars is important for increasing patient access, potentially at a lower cost.
Comparison of injectable osteoporosis treatments
Different injectable options are suited for different patient profiles. Here is a comparison of some prominent injectable treatments, including the newest options.
| Feature | Evenity (Romosozumab) | Denosumab (Prolia) & Biosimilars | Teriparatide (Forteo) & Abaloparatide (Tymlos) |
|---|---|---|---|
| Approval Year (Original) | 2019 (Evenity) | 2010 (Prolia), 2024 (Biosimilars) | 2002 (Forteo), 2017 (Tymlos) |
| Mechanism of Action | Dual-action: Increases bone formation and decreases bone resorption. | Anti-resorptive: Blocks RANKL to prevent bone breakdown. | Anabolic: Stimulates osteoblasts to build new bone. |
| Administration Frequency | Monthly injection for 12 months. | Injection every 6 months. | Daily injection, typically for 2 years. |
| Primary Use Case | Postmenopausal women at very high fracture risk. | High-risk postmenopausal women and men with osteoporosis. | Severe osteoporosis, treatment failures, very low bone density. |
| Follow-up Therapy | Requires a follow-up anti-resorptive agent. | Ongoing treatment often needed; discontinuation can cause rapid bone loss. | Followed by an anti-resorptive agent. |
| Notable Side Effects | Cardiovascular risks, headaches, joint pain. | Hypocalcemia, infections, osteonecrosis of the jaw. | Nausea, dizziness, leg cramps. |
Other notable injectables
Other injectable treatments have been available longer but remain important options. These include Teriparatide (Forteo) and Abaloparatide (Tymlos), which are daily injections for up to two years that stimulate bone growth in severe cases. Zoledronic Acid (Reclast) is an annual intravenous infusion that slows bone breakdown, suitable for those who struggle with daily medications.
The importance of discussing options with your doctor
Choosing the right treatment involves considering individual factors like bone loss severity, fracture history, risk factors, and overall health. A healthcare provider will assess your fracture risk, existing conditions, and treatment goals to determine the best option.
Conclusion
What is the newest injection for osteoporosis has two answers: Evenity (romosozumab), approved in 2019, is the newest type of bone-building injection used for one year. However, the most recent FDA approvals in 2024 are for denosumab biosimilars (Jubbonti and Wyost), providing more accessible anti-resorptive treatment options. A doctor can help determine the safest and most effective injectable for individual needs.
