Pharmacogenomics of osteoporosis: opportunities and challenges.

The genetics of osteoporosis can be considered in two broad areas: disease susceptibility and drug activity. While the former has been studied, the latter is still largely untouched. Pharmacogenomics is the utilization of genetic information to predict outcome of drug treatment, with respect to both beneficial and adverse effects. The pharmacotherapy of osteoporosis is characterized by variability in therapeutic response with limited prediction of response on a patient-by-patient basis. This is particularly problematic in a clinical situation where therapy is typically required for several years before outcomes can be evaluated for an individual. Thus, the emerging field of pharmacogenomics holds great potential for refining and optimising pharmacological treatment of osteoporosis. Key components for future development of the pharmacogenomics of osteoporosis should include improved understanding of mechanisms of drug action, identification of candidate genes and their variants and expansion of clinical trials to include genetic profiling. This approach could provide clinicians and scientists with powerful tools to dissect novel molecular pathways involved in osteoporosis and to identify new drug targets. The iterative combination of innovative genomics with classical endocrinological approaches in osteoporosis research can be examined as a model of biological research and innovate therapeutical approaches in a continuing interaction between clinical science and basic research.