TY - JOUR
T1 - Management of patients at very high risk of osteoporotic fractures through sequential treatments
AU - Curtis, Elizabeth M
AU - Reginster, Jean-Yves
AU - Al-Daghri, Nasser
AU - Biver, Emmanuel
AU - Brandi, Maria Luisa
AU - Cavalier, Etienne
AU - Hadji, Peyman
AU - Halbout, Philippe
AU - Harvey, Nicholas C
AU - Hiligsmann, Mickaël
AU - Javaid, M Kassim
AU - Kanis, John A
AU - Kaufman, Jean-Marc
AU - Lamy, Olivier
AU - Matijevic, Radmila
AU - Perez, Adolfo Diez
AU - Radermecker, Régis Pierre
AU - Rosa, Mário Miguel
AU - Thomas, Thierry
AU - Thomasius, Friederike
AU - Vlaskovska, Mila
AU - Rizzoli, René
AU - Cooper, Cyrus
N1 - © 2022. The Author(s).
PY - 2022/4
Y1 - 2022/4
N2 - Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an "anabolic first" approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon.
AB - Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an "anabolic first" approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon.
KW - Anabolic
KW - Antiresorptive
KW - BONE-MINERAL DENSITY
KW - COST-EFFECTIVENESS
KW - Epidemiology
KW - FRAGILITY FRACTURE
KW - Fracture
KW - HIP FRACTURE
KW - Imminent
KW - Osteoporosis
KW - PARATHYROID-HORMONE 1-34
KW - PATIENTS PREFERENCES
KW - POSTMENOPAUSAL WOMEN
KW - TERM DENOSUMAB TREATMENT
KW - VERTEBRAL FRACTURES
KW - ZOLEDRONIC ACID
U2 - 10.1007/s40520-022-02100-4
DO - 10.1007/s40520-022-02100-4
M3 - (Systematic) Review article
C2 - 35332506
SN - 1594-0667
VL - 34
SP - 695
EP - 714
JO - Aging Clinical and Experimental Research
JF - Aging Clinical and Experimental Research
IS - 4
ER -