Osteoporosis: Current and emerging therapies targeted to immunological checkpoints

Osteoporosis is a skeletal pathology characterized by compromised bone strength leading to increased risk of fracture, mainly spine and hip fractures. Osteoporosis affects more than 200 million people worldwide and because of the skeletal fractures it causes, represents a major cause of morbidity, disability and mortality in older people. Recently the new discoveries of osteoimmunology have clarified many of the pathogenetic mechanisms of osteoporosis, helping to identify new immunological targets for its treatment opening the way for new and effective therapies with biological drugs. Currently, there are basically two monoclonal antibodies for osteoporosis therapy: denosumab and romosozumab. Here we focus on the modern approach to the osteoporosis management and in particular on current and developing biologic drugs targeted to new immunological checkpoints, in the landscape of osteoimmunology.