Overview of the development of selective androgen receptor modulators (SARMs) as pharmacological treatment for osteoporosis (1998-2021).

Osteoporosis is a common disease in which the risk of fracture increases due to decreased bone mass and qualitative skeletal changes. Selective androgen receptor modulators (SARMs) are agonists with tissue selectivity, which act as partial or weak androgen receptor (AR) agonists in androgenic tissues, but mainly as complete AR agonists in synthetic metabolic tissues. In the recent 20 years, many scaffolds of SARMs have been reported, among which several molecules are promising and are undergoing clinical trial evaluation. However, it is still a challenge to discover SARMs with high activity and reduced side effects. In this review, not only are structure of SARMs reported in the literatures systematically collected and classified but also the structure-activity relationships (SAR) are systematically summarized. Furthermore, the advances in SARMs as potential treatment for osteoporosis are also updated.