Which of the following are anabolic agents used to build bone in osteoporosis?

• A. Bisphosphonates
• B. Anabolics such as teriparatide, abaloparatide, PTH, and romosozumab
• C. Calcitonin
• D. Estrogen therapy

Answer: (B)

Anabolic agents build bone by directly stimulating osteoblast activity, increasing bone formation and, over time, bone mineral density and fracture resistance. Teriparatide and abaloparatide are PTH receptor agonists given intermittently to favor bone formation. Romosozumab blocks sclerostin, boosting Wnt signaling, which also promotes bone formation (and later helps reduce resorption). Together, these drugs actively increase bone mass rather than just slowing its loss, making them the correct choice for building bone in osteoporosis.

In contrast, bisphosphonates inhibit osteoclasts to slow resorption (antiresorptive), calcitonin also reduces resorption, and estrogen therapy lowers bone turnover rather than primarily increasing new bone formation.