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 contribute to market growth through 2029. However, this 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 constrain the market. Driven largely by their widespread generic availability and high 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-benefit balance at a competitive price to challenge the bisphosphonates in the first line. Therefore, most emerging therapies will compete for use as second- or third-line treatments.

Questions Answered:

  • Novel agents—Radius Health’s abaloparatide TD (Phase III) and Amgen / UCB / Astellas's romosuzumab (first market launch in 2019) for the treatment of osteoporosis. What do interviewed thought leaders say about the advantages and disadvantages of each therapy? How do they anticipate using these agents in the osteoporosis treatment algorithm? Which agents in the current market are most likely to be replaced by these novel therapies, and which will constrain the uptake of new drugs?
  • The bisphosphonate drug class (e.g., alendronate, risedronate, ibandronate, zoledronate) is the dominant 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: 19 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

  • Osteoporosis - Landscape & Forecast - Disease Landscape & Forecast

Author(s): Shambhavi Shukla

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 B.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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