Personalisierte Osteoporose-Therapie

2019 ◽  
Vol 144 (16) ◽  
pp. 1111-1119
Author(s):  
Karoline Schulz ◽  
Hannes Kalscheuer ◽  
Hendrik Lehnert
Keyword(s):  
Fracture Risk ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
High Fracture ◽  
Osteoporosis Therapy ◽  
Treatment Of Osteoporosis ◽  
First Line Therapy ◽  
Severity Of The Disease ◽  
The Individual ◽  
Care Costs

AbstractIn Germany, over six million people suffer from osteoporosis. Nearly half of the women over 70 years and nearly 20 % of men at the same age are affected. The clinical and socioeconomical relevance of the disease lies in osteoporotic fractures leading to extensive bone-associated morbidity, increased mortality and health care costs. Fracture risk algorithms and guidelines for the diagnosis and treatment of osteoporosis help to assess the individual fracture risk. By calculating the individual fracture risk, the indication for specific osteoporosis treatment can objectively be determined. A consequent specific osteoporosis therapy is required for patients with a high fracture risk and is essential to prevent osteoporotic fractures and their consequences. As first-line therapy a drug with a proven fracture-reducing effect should be taken. However, for successful osteoporosis therapy, many individual factors have to be considered. A personalized treatment approach should be established according to the severity of the disease, the patient’s sex and comorbidities as well as the possible additive and side effects of the drug.

scholarly journals Current Challenges in Osteoporosis Treatment Discontinuation

2021 ◽  
Vol 47 (3) ◽  
pp. 17-18
Author(s):  
Tang Ching Lau
Keyword(s):  
Fracture Risk ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Bisphosphonate Therapy ◽  
Treat To Target ◽  
Mineral Density ◽  
High Fracture ◽  
Osteoporosis Therapy ◽  
Increased Risk ◽  
Rebound Increase

Osteoporosis is a chronic disease that may require lifelong therapy. Therefore, evidence-based approach regarding the efficacy and safety of long‐term osteoporosis therapy and therapy discontinuation is important. The most important goals for osteoporosis and fragility fracture patients are the recovery of pre-fracture functional level and reduction of fracture risk. There has been increasing consensus that a treat-to-target (T2T) strategy is applicable to osteoporosis and that bone mineral density (BMD) is currently the most clinically appropriate target. However, there is no clear consensus with regard to the definition of a specific BMD treatment target and timeframes applicable to T2T in osteoporosis, and these would need to be individually determined. Treatment with bisphosphonates may be interrupted after 3-5 years, only in patients in whom fracture risk is low or lowered because of the treatment itself. It is recommended never to discontinue treatment in patients with one or more prevalent osteoporotic fractures or in whom the BMD values are still below -2.5 (T score). Recent reports imply that denosumab discontinuation may lead to an increased risk of multiple vertebral fractures. Patients considered at high fracture risk should either continue denosumab therapy for up to ten years or be switched to an alternative treatment. For patients at low-risk, a decision to discontinue denosumab could be made after five years, but bisphosphonate therapy should be considered to reduce or prevent the rebound increase in bone turnover.

scholarly journals Pharmacologic treatment of osteoporosis – 2011

2011 ◽  
Vol 152 (33) ◽  
pp. 1320-1326 ◽  
Author(s):  
Péter Lakatos
Keyword(s):  
Bone Loss ◽  
Fracture Risk ◽  
Hormone Replacement ◽  
Treatment Options ◽  
Osteoporotic Fractures ◽  
Cost Effective ◽  
Similar Efficacy ◽  
High Fracture ◽  
Efficient Treatment ◽  
Treatment Of Osteoporosis

Osteoporosis affects approximately 9% of the population in Hungary resulting in about 100 000 osteoporotic fractures annually. Thirty-five percent of patients with hip fractures due to osteoporosis will die within 1 year. Direct costs of osteoporosis exceed 25 billion forints per year. Apparently, cost-effective reduction of bone loss and consequent fracture risk will add up to not only financial savings but improvement in quality of life, as well. A number of pharmacological modalities are available for this purpose. The mainstay of the treatment of osteoporosis is the bisphosphonate group that includes effective anti-resorptive compounds mitigating bone loss and fragility. The recently registered denosumab exhibits similar efficacy by neutralizing RANK ligand, however, marked differences can be observed between the two drug classes. Strontium has a unique mechanism of action by rebalancing bone turnover, and thus, providing an efficient treatment option for the not fast bone losers who are at high fracture risk. The purely anabolic teriparatide is available for the extremely severe osteoporotic patients and for those who do not respond to other types of therapy. Older treatment options such as hormone replacement therapy, raloxifene, tibolone or calcitonin may also have a restricted place in the management of osteoporosis. Orv. Hetil., 2011, 152, 1320–1326.

scholarly journals 08 Evidence Base for Treatment of Osteoporosis in Older People

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv3-iv3
Author(s):  
Tahir Masud
Keyword(s):  
Oldest Old ◽  
Age Groups ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Fracture Reduction ◽  
Older Population ◽  
Term Care ◽  
Treatment Of Osteoporosis ◽  
Post Hoc Analysis ◽  
Post Hoc

Abstract After the age of fifty years the prevalence of osteoporosis and incidence of osteoporotic fractures rise substantially with age. It is ironic however that the pivotal trials for the common drugs used to treat osteoporosis mainly recruited participants under the age of 80 years leading some to question the use of these drugs in the older population. This talk explores the evidence accumulated for the treatment of osteoporosis in the frailer older population. The FOSIT trial showed a 47% reduction in non-vertebral fractures with alendronate in people up to 84 years, and a study in long term care in those up to 91 years showed a significant improvement in bone density at the spine and hip. A post hoc analysis of the risedronate HIP trial in people aged 70-100 years with established osteoporosis showed a 47% reduction in hip fractures. In the zoledronic acid Horizon studies fractures were significantly reduced in a population up to the age of 89 years and mortality was reduced by 28%, with half of the participants being older than 75 years. Interestingly a post hoc analysis showed that those participants who ended up having only a single infusion had a reduction of all clinical fractures at 3 years. The Freedom trial of denosumab was performed in a population aged up to 90 years with significant fracture reduction across all age groups. Studies with the anabolic agent teriparatide showed that vertebral and non-vertebral fracture reduction occurred in both the under and over 75 age groups. Trials with the recently developed agents abaloparatide and romosozumab have shown significant fracture reductions in populations up to ages of 86 and 90 years respectively. There is now enough evidence to suggest that the oldest old should be considered for osteoporosis treatment as well having a focus on falls reduction.

scholarly journals The epidemiology of osteoporosis

2020 ◽  
Author(s):  
Michael A Clynes ◽  
Nicholas C Harvey ◽  
Elizabeth M Curtis ◽  
Nicholas R Fuggle ◽  
Elaine M Dennison ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Economic Burden ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Ageing Population ◽  
Mineral Density ◽  
High Fracture ◽  
Osteoporosis Screening ◽  
The Usa ◽  
Receive Treatment

Abstract Introduction With a worldwide ageing population, the importance of the prevention and management of osteoporotic fragility fractures is increasing over time. In this review, we discuss in detail the epidemiology of fragility fractures, how this is shaped by pharmacological interventions and how novel screening programmes can reduce the clinical and economic burden of osteoporotic fractures. Sources of data PubMed and Google Scholar were searched using various combinations of the keywords ‘osteoporosis’, ‘epidemiology’, ‘fracture’, ‘screening’, `FRAX’ and ‘SCOOP’. Areas of agreement The economic burden of osteoporosis-related fracture is significant, costing approximately $17.9 and £4 billion per annum in the USA and UK. Areas of controversy Risk calculators such as the web-based FRAX® algorithm have enabled assessment of an individual’s fracture risk using clinical risk factors, with only partial consideration of bone mineral density (BMD). Growing points As with all new interventions, we await the results of long-term use of osteoporosis screening algorithms and how these can be refined and incorporated into clinical practice. Areas timely for developing research Despite advances in osteoporosis screening, a minority of men and women at high fracture risk worldwide receive treatment. The economic and societal burden caused by osteoporosis is a clear motivation for improving the screening and management of osteoporosis worldwide.

scholarly journals Pins and Plaster Aren’t Enough: A Call for the Evaluation and Treatment of Patients with Osteoporotic Fractures

2003 ◽  
Vol 88 (8) ◽  
pp. 3482-3486 ◽  
Author(s):  
Ethel S. Siris ◽  
John P. Bilezikian ◽  
Mishaela R. Rubin ◽  
Dennis M. Black ◽  
Richard S. Bockman ◽  
...  
Keyword(s):  
Vitamin D ◽  
Fracture Risk ◽  
Primary Care Physicians ◽  
Osteoporotic Fractures ◽  
Standard Of Care ◽  
Pharmacological Therapy ◽  
Diagnostic Tools ◽  
Osteoporosis Therapy ◽  
Call To Action ◽  
History Of

A history of an osteoporotic fracture is a powerful predictor of future fractures. Older patients who sustain low trauma fractures are candidates for interventions that should include confirmation of the diagnosis of osteoporosis, adequate calcium and vitamin D administration, and use of an osteoporosis therapy that is proven to lower fracture risk. Recently, however, several reports in the literature have indicated that, in general, those physicians who diagnose and treat fractures, i.e. radiologists, orthopedic surgeons, physiatrists, and those who provide general medical care to these fracture patients, the primary care physicians, are not evaluating patients with acute fractures for the presence of osteoporosis and are not prescribing calcium, vitamin D, or specific pharmacological therapy to reduce future fracture risk. These reports suggest that implementation of a standard of care for the subsequent medical management of the older patient with an acute fracture is needed urgently. Diagnostic tools and several effective therapies exist, but these are underused by the physicians who interface with these patients. A call to action is necessary to reduce the human and economic costs associated with this serious and treatable disease.

scholarly journals Under-Recognition of Fractures as Osteoporosis Indicators

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 9 ◽  
Author(s):  
Violet S. Lagari ◽  
Fatima Al-Yatama ◽  
Gracielena Rodriguez ◽  
Hara R. Berger ◽  
Silvina Levis
Keyword(s):  
Older Adults ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
Diagnosis Of Osteoporosis ◽  
International Classification Of Disease ◽  
T Score ◽  
Traumatic Fracture ◽  
Receive Treatment

After the first fracture, the risk of subsequent fractures increases significantly. Medical treatment can reduce the risk of a second fracture by about 50%, but many older adults do not receive osteoporosis medication following their first fracture. This observational study aimed to understand primary care management patterns of older adults after osteoporotic fractures at the Miami Veterans Affairs (VA) Healthcare System. A retrospective review of 219 fracture cases selected by International Classification of Disease (ICD-9) codes between October 2015 and September 2016 identified 114 individuals age ≥50 years who had a non-traumatic fracture code entered in their medical record for the first time. Among them, 72 (63%) did not undergo a bone mineral density (BMD) test or receive treatment in the 12 months following their fracture. Of the 40 individuals who had a BMD test post-fracture, 17 (100%) received or were considered for anti-osteoporosis treatment if their T-score indicated osteoporosis (T-score ≤−2.5), but only 8/23 (35%) if the T-score was >−2.5. Physicians are more likely to prescribe osteoporosis therapy based on a BMD T-score diagnosis of osteoporosis, rather than a clinical diagnosis of osteoporosis based on a low-trauma fracture. A change in practice patterns is necessary to decrease the incidence of fractures.

scholarly journals The management of patient with osteoporosis in clinical practice

ABOUTOPEN ◽  
2021 ◽  
Vol 8 ◽  
pp. 1-5
Author(s):  
Luca Degli Esposti ◽  
Elisa Giacomini ◽  
Alessandro Ghigi ◽  
Valentina Perrone
Keyword(s):  
Clinical Practice ◽  
Fracture Risk ◽  
Osteoporosis Treatment ◽  
Bone Fragility ◽  
Key Factors ◽  
Osteoporosis Therapy ◽  
Adequate Treatment ◽  
Periodic Monitoring ◽  
Suboptimal Adherence ◽  
Audit Activity

Osteoporosis is a systemic skeletal disorder characterized by increased bone fragility, which is associated with an enhanced fracture risk. The first fracture often represents indeed the clinical manifestation of this condition. In the present document we provided an overview of the economic and clinical impact of a not-adequate therapeutic appropriateness and suboptimal adherence to osteoporosis therapy, that are both widely reported in literature despite osteoporotic treatments have proved their efficacy in reducing fracture risk. Adequate treatment and adherence were reported to be associated with a lower risk of re-fracture and all-cause mortality. Moreover, healthcare costs in osteoporotic patients with previous fractures were significantly lower in those receiving osteoporosis treatment rather than among untreated patients. Nevertheless, these two key-factors are not improving over time. The measurement of indicators of adherence and therapeutic appropriateness allows to analyse the utilization profile of the drugs indicated for the treatment of osteoporosis and to evaluate the presence of possible deviation between the prescriptive behaviours observed in clinical practice and the recommendations reported in the guidelines. The periodic monitoring of such indicators together with prescribing audit activity could represent a useful tool for the optimization of osteoporosis management and to achieve a correct resource allocation.

scholarly journals Evaluation of fracture risk in osteoporosis

2011 ◽  
Vol 152 (33) ◽  
pp. 1304-1311 ◽  
Author(s):  
Miklós Szathmári
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Absolute Risk ◽  
Treatment Options ◽  
Osteoporotic Fractures ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
High Fracture ◽  
Parental History ◽  
Clinical Risk

Osteoporotic fractures are associated with excess mortality. Effective treatment options are available, which reduce the risk of vertebral and non-vertebral fractures, but the identification of patients with high fracture risk is problematic. Low bone mineral density (BMD) – the basis for the diagnosis of osteoporosis – is an important, but not the only determinant of fracture risk. Several clinical risk factors are know that operate partially or completely independently of BMD, and affect the fracture risk. These include age, a prior fragility fracture, a parental history of hip fracture, use of corticosteroids, excess alcohol intake, rheumatoid arthritis, and different types of diseases which can cause secondary bone loss. The FRAX® tool integrates the weight of above mentioned clinical risk factors for fracture risk assessment with or without BMD value, and calculates the 10-year absolute risk of hip and major osteoporotic (hip, vertebral, humerus and forearm together) fracture probabilities. Although the use of data is not yet uniform, the FRAX® is a promising opportunity to identify individuals with high fracture risk. The accumulation of experience with FRAX® is going on and it can modify current diagnostic and therapeutic recommendations in Hungary as well. Orv. Hetil., 2011, 152, 1304–1311.

scholarly journals Osteoporosis Medication and Reduced Mortality Risk in Elderly Women and Men

2011 ◽  
Vol 96 (4) ◽  
pp. 1006-1014 ◽  
Author(s):  
Jacqueline R. Center ◽  
Dana Bliuc ◽  
Nguyen D. Nguyen ◽  
Tuan V. Nguyen ◽  
John A. Eisman
Keyword(s):  
Mortality Risk ◽  
Elderly Women ◽  
Osteoporotic Fractures ◽  
Premature Mortality ◽  
Osteoporosis Treatment ◽  
Mortality Rates ◽  
Quadriceps Strength ◽  
Community Dwelling ◽  
Mineral Density ◽  
Osteoporosis Therapy

Abstract Context: Osteoporotic fractures are associated with premature mortality. Antiresorptive treatment reduces refracture but mortality reduction is unclear. Objective: The objective of the study was to examine the effect of osteoporosis treatment [bisphosphonates (BP), hormone therapy (HT), and calcium ± vitamin D only (CaD)] on mortality risk. Design: This was a prospective cohort study (April 1989 to May 2007). Setting: The study was conducted with community-dwelling elderly (aged 60+ yr) subjects in Dubbo, a semiurban city, Australia. Subjects: Subjects included 1223 and 819 women and men in the Dubbo Osteoporosis Epidemiology Study. Main Outcome Measure: Mortality according to treatment group was recorded. Results: There were 325 (BP, n = 106; HT, n = 77; CaD, n = 142) women and 37 men (BP, n = 15; CaD, n = 22) on treatment. In women, mortality rates were lower with BP 0.8/100 person-years (0.4, 1.4) and HT 1.2/100 person-years (0.7, 2.1) but not CaD 3.2/100 person-years (2.5, 4.1) vs. no treatment 3.5/100 person-years (3.1, 3.8). Accounting for age, fracture occurrence, comorbidities, quadriceps strength, and bone mineral density, mortality risk remained lower for women on BP [hazard ratio (HR) 0.3 (0.2, 0.6)] but not HT [HR 0.8 (0.4, 1.8)]. For 429 women with fractures, mortality risk was still reduced in the BP group [adjusted HR 0.3 (0.2, 0.7)], not accounted for by a reduction in subsequent fractures. In men, lower mortality rates were observed with BP but not CaD [BP 1.0/100 person-years (0.3, 3.9) and CaD 3.1/100 person-years (1.5, 6.6) vs. no treatment 4.3/100 person-years (3.9, 4.8)]. After adjustment, mortality was similar, although not significant [HR 0.5 (0.1, 2.0)]. Conclusions: Osteoporosis therapy appears to reduce mortality risk in women and possibly men.

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