pereira et al

Osteoporosis is a silent metabolic bone disease, usually identified only after the first fracture, and is becoming increasingly important due to the ageing population, especially women. The post-menopausal form is the result of an estrogen deficit due to ovarian failure, compromising bone remodeling by acting on receptors present in osteoblasts, osteoclasts and immune cells. Recent evidence also suggests that oestrogens preserve the homeostasis of the microbiota and the integrity of the intestinal barrier, preventing inflammation and pro-reabsorptive cytokines. Although not fatal, the disease significantly reduces quality of life and involves high costs. Therapeutic options include anabolic drugs, such as teriparatide and romosozumab, and anti-resorptive agents, such as bisphosphonates, denosumab, selective estrogen receptor modulators, calcitonin and hormone therapy. Innovative strategies are expected to be developed, including tissue engineering and new molecular targets.