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.

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 64 Association between Risk of Osteoporotic Fractures with Spinal Morphology, Muscle Strength and Physical Performance

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Siew Kuan Chua ◽  
Devinder ◽  
KA Singh ◽  
Bala S Rajaratnam ◽  
Sabarul Afian Mokhtar ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Fracture Risk ◽  
Physical Performance ◽  
Tracking System ◽  
Osteoporotic Fractures ◽  
Limited Information ◽  
Functional Impairments ◽  
Mineral Density ◽  
Increased Risk ◽  
Study Results

Abstract Osteoporotic related fractures (OF) are associated with functional impairments and declined quality of life. Low bone mineral density is one of the main risk factor for OF. However, there is limited information regarding the association of spinal morphology, muscle strength and physical performance with OF. The aim of the study was to examine association between risk of osteoporotic fractures with spinal morphology (thoracolumbar curvature and back extensors muscle strength), muscle strength and physical performance. 105 adults aged 50 years and above (69.3+ 8.5 years) were recruited for this cross-sectional study from a spine orthopaedic clinic. Thoracolumbar curvature, back extensors (BEMS) and handgrip (HGS) muscle strength were measured using an electromagnetic tracking system, a load-cell system and hand-held dynamometer respectively. Physical performance was assessed using Short Physical Performance Battery (SPPB). Participants were categorised for major osteoporotic fracture risk (major OF) with cut-point 10% using fracture risk calculator (FRAX®) with BMD. Student t-test analysis demonstrated that there is a significant (p<0.05) difference between participants with low risk and moderate to high risk of major OF for BEMS, HGS, and SPPB. Adjusted logistic models (forward and backward), showed that lower HGS and physical performance were associated with increased risk of major OF (HGS: OR = 0.18 [95% CI, 0.07–0.48]; SPPB: OR = 0.32[95% CI, 0.13–0.80]). Our study results suggest that declined muscle strength and physical performance is associated with higher risk of OF. It is important to promote optimum muscle strength and physical performance among older adults in the prevention of OF.

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 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 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.

scholarly journals Menopausal osteoporosis in the practice of a gynecologist

2021 ◽  
pp. 320-331
Author(s):  
I. V. Kuznetsova ◽  
R. A. Chilova
Keyword(s):  
At Risk ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Risk Groups ◽  
Health Examination ◽  
Bolus Administration ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
Antiresorptive Agents ◽  
Increased Risk

Osteoporosis represents a great healthcare challenge due to an increased risk of fragility fractures that significantly decreases quality of life, shortens life expectancy, and looms as an onerous burden on both the social environment of patients and society as a whole. Osteoporotic fractures can’t be prevented without early diagnosis of low bone mineral density in people at risk. Unfortunately, the population at risk of osteoporosis is not covered by the periodic health examination program in real practice, and involving doctors of different specialties in the prevention and treatment of this disease is one of the options for addressing the challenge. As the risk of osteoporosis is associated with age and estrogen deficiency in women, the gynecologist can and should assume responsibility for the formation of risk groups, monitoring and timely recommendations on preventive and therapeutic actions. The gynecologist’s possibilities should not be reduced solely to recommendations for correcting lifestyle and prescribing menopausal hormone therapy. Antiresorptive agents of the first-line osteoporosis therapy may also be included in the gynecologist’s drug arsenal. Among them are the most commonly used bisphosphonates that are characterized by a good efficacy and safety profile during the long-term use. However, oral administration of bisphosphonates is associated with low compliance due to adverse reactions and the need for strict observance of the rules for their administration. In contrast, intravenous administration of bisphosphonates improves compliance and allows to ensure the optimal treatment outcome. Ibandronate intended for intravenous bolus administration once every three weeks for 5 years is one of the possibilities of using parenteral bisphosphonate therapy in the practice of gynecology. 

The Clinical Use of Denosumab for the Management of Low Bone Mineral Density in Postmenopausal Women

2012 ◽  
Vol 25 (3) ◽  
pp. 310-318 ◽  
Author(s):  
Kira B. Harris ◽  
Kimberly L. Nealy ◽  
Delilah J. Jackson ◽  
Phillip L. Thornton
Keyword(s):  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Hip Fractures ◽  
Nuclear Factor Κb ◽  
Bisphosphonate Therapy ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
Cost Of Health Care ◽  
Therapy Studies

Osteoporosis is a leading cause of debility and declining quality of life in postmenopausal women worldwide. Treatment of osteoporosis has been ubiquitous throughout the developed world since the mid-1990s, most notably with the introduction of bisphosphonates in 1995. Nonetheless, the incidence of hip fractures increased by 25% between 1990 and 2000, despite advances in osteoporosis therapy. Studies indicate that bone density increases over the first 3 years of bisphosphonate therapy and then plateaus or perhaps even declines, placing these patients at greater risk of fracture. Since hip fractures are associated with increased morbidity, mortality, and increased cost of health care, improvements in treating osteoporosis are critical. Denosumab is a novel monoclonal antibody targeted against the receptor activator of nuclear factor-κB ligand (RANKL) that inhibits osteoclast activity. Initial data suggest that denosumab increases bone mineral density for greater than 3 years. Of greater importance, denosumab has been shown to decrease vertebral fractures by 68%, nonvertebral fractures by 19%, and hip fractures by 42% for at least 36 months. Data also indicate that the safety profile of denosumab is equivalent to other drugs used in osteoporosis management, but potential risks of immunosuppression and cancer have been hypothesized.

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.

Comparative Efficacy of Alendronate upon Vertebral Bone Mineral Density and Fracture Rates in East Asians Versus Non-East Asians with Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 50 (10) ◽  
pp. 738-746 ◽  
Author(s):  
Yexin Wang ◽  
Gongwei Jia ◽  
Jin Song ◽  
Xiangqing Kong ◽  
Weihong Zhang ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Fracture Risk ◽  
Postmenopausal Osteoporosis ◽  
Meta Analysis ◽  
East Asian ◽  
Bisphosphonate Therapy ◽  
Mineral Density ◽  
East Asians ◽  
Vertebral Fracture Risk ◽  
Lumbar Spinal

AbstractBisphosphonates, such as alendronate, have become the most widely used and effective anti-resorptive therapy for postmenopausal osteoporosis. Previous genetic studies suggest that ethnicity may drive differing responses to bisphosphonate therapy in East Asians and non-East Asians. Therefore, the aim of this study was to comparatively evaluate the efficacy of alendronate upon lumbar spinal BMD and vertebral fracture rates in East Asians and non-East Asians with postmenopausal osteoporosis. MEDLINE, EMBASE, and Cochrane CENTRAL were searched for relevant randomized controlled trials (RCTs) comparing the efficacy of alendronate versus placebo (or calcium/mineral and/or Vitamin D or hormone replacement therapy) in primary postmenopausal osteoporotic women. We calculated the weighted mean differences (WMDs) for lumbar spinal BMD and the risk ratios (RRs) for vertebral fracture risk along with their respective 95% confidence intervals (CIs). From an initial set of 445 non-duplicate records, 13 full-text articles were finally included in this meta-analysis consisting of four East Asian RCTs and nine non-East Asian RCTs. Alendronate therapy displayed significant effects in improving lumbar spinal BMD in both East Asians [WMD (95% CI)=5.30 (0.32–10.29), p=0.037] and non-East Asians [WMD (95% CI)=5.73 (3.61–7.85), p=0.000]. Alendronate therapy did not display significant effects upon vertebral fracture risk in East Asians [RR (95% CI)=0.41 (0.06–2.73), p=0.358] but did display a significant effect upon lowering vertebral fracture risk in non-East Asians [RR (95% CI)=0.55 (0.42–0.72), p=0.000]. These findings suggest that ethnicity may affect the efficacy of bisphosphonate therapy in postmenopausal osteoporotic women.

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