With an increasing prevalence, due to aging populations, the major-market osteoporosis patient pool is large and growing. The combined influence of increased patient numbers and drug launches will support the market through 2029. However, market growth will be tempered by generic erosion of key brands. The relatively low diagnosis and drug-treatment rates for osteoporosis, owing to the asymptomatic nature of the disease, will also continue to hold back the market. Driven largely by their widespread generic availability and strong physician familiarity, bisphosphonates continue to dominate first-line treatment, creating a significant barrier to uptake for novel therapies. Emerging therapies will need to demonstrate a significant risk-clinical-benefit balance, at a competitive price, to challenge the bisphosphonates as first-line treatments. Therefore, most emerging therapies will compete for use as second- or third-line treatments.

Questions Answered:

  • Novel agents—Radius Health’s abaloparatide TD and Amgen / UCB romosozumab—are in late-phase development or have recently launched for the treatment of osteoporosis. What do interviewed thought leaders say about the advantages and disadvantages of each therapy? How do they anticipate using them in the osteoporosis treatment algorithm? Which agents in the current market are most vulnerable to being replaced by these novel therapies, and which will constrain the uptake of the new drugs?
  • The bisphosphonate drug class (e.g., alendronate, risedronate, ibandronate, zoledronate) is the dominant drug class for the treatment of osteoporosis but is associated with adverse effects, including osteonecrosis of the jaw and an elevated risk of atypical femoral fractures. How much impact will this association have on osteoporosis drug-treatment rates? To what extent will this association adversely affect bisphosphonate sales?
  • Teriparatide and denosumab hold a sizable share of the market. How will the loss of patent protection affect their market share? What effect will the launch of novel agents have on their patient share?


Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, Japan.

Primary research: 20 country-specific interviews with experts.

Epidemiology: Prevalence of osteoporosis by country, with diagnosis and drug treatment rates.

Population segments in market forecast: Osteoporosis.

Emerging therapies: Phase III: 1 drug; Phase II: 1 drug. Coverage of select preclinical and Phase I products.

Key drugs: Denosumab, teriparatide, abaloparatide SC, abaloparatide TD, alendronate, romosozumab, raloxifene.

Table of contents

  • Disease Landscape & Forecast
    • COVID-19
    • Key Updates
      • May 2020
        • May 2020
      • January 2020
      • November 2018
      • August 2018
      • April 2018
    • Market Outlook
      • Key Findings
        • Market Overview
      • COVID-19: Areas of Potential Forecast Impact
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Osteoporosis?
        • What Factors Are Constraining the Market for Osteoporosis?
      • Drug-Class-Specific Trends
        • Bisphosphonates
        • Selective Estrogen Receptor Modulators
        • Parathyroid Analogues
        • RANKL Inhibitors
        • Calcitonins
        • Sclerostin Inhibitors
        • Strontium Salts
        • Other Therapies
    • Forecast
      • Market-Forecast-Assumptions
      • Market Forecast Dashboard
    • Etiology and Pathophysiology
      • Disease Overview
      • Etiology
        • Primary Osteoporosis
        • Secondary Osteoporosis
        • Risk Factors
        • Osteoporosis: A Risk Factor for Fractures
      • Key Pathways and Drug Targets
        • Anatomy
        • Bone Remodeling and Turnover
        • Immunologic Effects
        • Drug Targets
    • Epidemiology
      • Introduction
      • Epidemiology Populations
        • Total Prevalence of Osteoporosis and Osteopenia
        • FRAX High-Risk
        • Diagnosed Prevalent Cases of Osteoporosis
        • Drug-Treated Cases of Osteoporosis
    • Current Treatment
      • Key Findings
      • Treatment Goals
      • Key Current Therapies
        • Overview
        • Bisphosphonates
        • Selective Estrogen Receptor Modulators
        • Parathyroid Hormone Analogues
        • RANKL Inhibitors
        • Sclerostin Inhibitors
        • Strontium Salts
        • Calcitonins
        • Hormone Replacement Therapy
        • Other Therapies to Treat Osteoporosis
      • Medical Practice
        • Overview
        • Treatment Guidelines
        • Region-Specific Treatment Practices
    • Unmet Need Overview
      • Current and Future Attainment of Unmet Needs in Osteoporosis
    • Emerging Therapies
      • Key Findings
      • Key Emerging Therapies
        • Notable Developments Among Key Emerging Therapies for Osteoporosis
        • Parathyroid Hormone Analogues
      • Early-Phase Pipeline Analysis
      • Key Discontinuations and Failures in Osteoporosis
    • Access & Reimbursement Overview
      • Region-Specific Reimbursement Practices
        • United States
        • EU5
        • Japan
        • Looking for More?
    • Methodology
      • Bottom-Up Forecasting Overview
        • Patient Populations
        • Drug-Specific Assumptions
      • Bottom-Up Forecast Assumptions
        • General Sources of Data
        • General Statements About Pricing
        • Dosing, Days of Therapy, and Compliance
        • Generic Erosion
        • Biosimilar Erosion
        • Out-Year Forecasting
        • Emerging Therapy Prices
      • Primary Market Research
        • Experts Interviewed
    • Appendix
      • Osteoporosis Bibliography
      • Supplemental Epidemiology Bibliography

Author(s): Shambhavi Shukla, MTech; Sunali D. Goonesekera, SM

Shambhavi Shukla, MTech ., is an analyst on the Cardiovascular, Metabolic, Renal, and Hematologic Disorders team at Decision Resources Group. Before joining DRG, Shambhavi was with Evalueserve for four years, where she worked closely with top pharmaceutical companies, assisting with commercial and technical ad-hoc requests. During her tenure, she delivered competitive landscape and market insight projects for various indications, including schizophrenia, multiple sclerosis, and myopia. She holds a master’s degree in biotechnology from Amity University, India.

Sunali Goonesekera is an Associate Epidemiologist at Decision Resources Group. Sunali holds a Master’s degree in Epidemiology from the Harvard School of Public Health and a in Biology (Honors) from Dartmouth College. Prior to joining Decision Resources Group, Sunali conducted epidemiological research and lead authored two manuscripts on racial/ethnic disparities in metabolic diseases at the New England Research Institutes. She has contributed to multiple publications in peer-reviewed journals in epidemiology and in the biological sciences.

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