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Goal-directed osteoporosis treatment: ASBMR/BHOF task force position statement 2024.
Cosman, Felicia; Lewiecki, E Michael; Eastell, Richard; Ebeling, Peter R; Jan De Beur, Suzanne; Langdahl, Bente; Rhee, Yumie; Fuleihan, Ghada El-Hajj; Kiel, Douglas P; Schousboe, John T; Borges, Joao Lindolfo; Cheung, Angela M; Diez-Perez, Adolfo; Hadji, Peyman; Tanaka, Sakae; Thomasius, Friederike; Xia, Weibo; Cummings, Steven R.
Afiliação
  • Cosman F; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States.
  • Lewiecki EM; New Mexico Clinical Research & Osteoporosis Center, Division of Metabolic Bone Diseases, Albuquerque, NM 87106, United States.
  • Eastell R; Division of Clinical Medicine, University of Sheffield, Sheffield S10 2RX, United Kingdom.
  • Ebeling PR; Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia.
  • Jan De Beur S; Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA 22908, United States.
  • Langdahl B; Department of Endocrinology, Aarhus University Hospital, Aarhus N 8200, Denmark.
  • Rhee Y; Department of Clinical Medicine, Aarhus University, Aarhus N 8200, Denmark.
  • Fuleihan GE; Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, South Korea.
  • Kiel DP; Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut 1107, Lebanon.
  • Schousboe JT; Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA 02131, United States.
  • Borges JL; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
  • Cheung AM; Division of Research and Evaluation, HealthPartners Institute, Bloomington MN 55425, United States.
  • Diez-Perez A; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55425, United States.
  • Hadji P; Brazil Clinical Research Center, Brasilia 71625-175, Brazil.
  • Tanaka S; Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, ON M5G 2C4, Canada.
  • Thomasius F; Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON M5G 2C4, Canada.
  • Xia W; Department of Medicine, Institute Hospital del Mar of Medical Investigation, Barcelona 08003, Spain.
  • Cummings SR; Department of Obstetrics and Gynecology, Frankfurt Center of Bone Health and Phillipps-University of Marburg, Frankfurt 60313, Germany.
J Bone Miner Res ; 39(10): 1393-1405, 2024 Sep 26.
Article em En | MEDLINE | ID: mdl-39073912
ABSTRACT
The overarching goal of osteoporosis management is to prevent fractures. A goal-directed approach to long-term management of fracture risk helps ensure that the most appropriate initial treatment and treatment sequence is selected for individual patients. Goal-directed treatment decisions require assessment of clinical fracture history, vertebral fracture identification (using vertebral imaging as appropriate), measurement of bone mineral density (BMD), and consideration of other major clinical risk factors. Treatment targets should be tailored to each patient's individual risk profile and based on the specific indication for beginning treatment, including recency, site, number and severity of prior fractures, and BMD levels at the total hip, femoral neck, and lumbar spine. Instead of first-line bisphosphonate treatment for all patients, selection of initial treatment should focus on reducing fracture risk rapidly for patients at very high and imminent risk, such as in those with recent fractures. Initial treatment selection should also consider the probability that a BMD treatment target can be attained within a reasonable period of time and the differential magnitude of fracture risk reduction and BMD impact with osteoanabolic versus antiresorptive therapy. This position statement of the ASBMR/BHOF Task Force on Goal-Directed Osteoporosis Treatment provides an overall summary of the major clinical recommendations about treatment targets and strategies to achieve those targets based on the best evidence available, derived primarily from studies in older postmenopausal women of European ancestry.
Goal-directed treatment can help healthcare providers recommend the best treatments for individual patients to prevent fractures. The goal-directed strategy considers the site, number, and recency of prior fractures. This may require imaging for spine fractures, which may not have caused pain. Treatment decisions also require bone mineral density (BMD) measurement and consideration of other major risk factors. In contrast to the standard approach, same first treatment for all, treatment selection is tailored to an individual's risk. In patients with recent fractures of the spine, hip, or pelvis, fracture risk is very high and treatment should rapidly reduce that risk. For others, the target is a specific BMD level and should consider the likelihood that the treatment target can be attained within a reasonable period of time, which differs for osteoporosis medications. After initial therapy, BMD should be assessed to determine if the target has been achieved. If so, strategies should focus on maintaining BMD. If the target is not yet achieved, treatment should be intensified, or continued if it is already the most potent option. This position statement represents a consensus of expert recommendations about treatment targets and strategies to achieve those targets based on the best available evidence.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteoporose / Densidade Óssea Limite: Female / Humans Idioma: En Revista: J Bone Miner Res Assunto da revista: METABOLISMO / ORTOPEDIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteoporose / Densidade Óssea Limite: Female / Humans Idioma: En Revista: J Bone Miner Res Assunto da revista: METABOLISMO / ORTOPEDIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos