Anabolic; Antiresorptive; Epidemiology; Fracture; Imminent; Osteoporosis; Geriatrics and Gerontology; Aging
Abstract :
[en] 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.
Disciplines :
Endocrinology, metabolism & nutrition Laboratory medicine & medical technology Public health, health care sciences & services
Author, co-author :
Curtis, Elizabeth M ; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
Reginster, Jean-Yves ; Université de Liège - ULiège > Unité de recherche Santé publique, épidémiologie et économie de la santé (URSAPES) ; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
Al-Daghri, Nasser ; Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia
Biver, Emmanuel ; Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
Brandi, Maria Luisa ; F.I.R.M.O, Italian Foundation for the Research on Bone Diseases, Florence, Italy
CAVALIER, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
Hadji, Peyman ; Center of Bone Health, Frankfurt, Germany ; Philipps-University of Marburg, Marburg, Germany
Halbout, Philippe; International Osteoporosis Foundation, Nyon, Switzerland
Harvey, Nicholas C ; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK ; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
Hiligsmann, Mickaël ; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
Javaid, M Kassim ; NDORMS, University of Oxford, Windmill Road, Oxford, UK
Kanis, John A ; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ; Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
Kaufman, Jean-Marc ; Department of Endocrinology, Ghent University Hospital, Gent, Belgium
Lamy, Olivier; University of Lausanne, UNIL, CHUV, Lausanne, Switzerland
Matijevic, Radmila ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia ; Clinical Center of Vojvodina, Clinic for Orthopedic Surgery, Novi Sad, Serbia
Perez, Adolfo Diez; Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Madrid, Spain
RADERMECKER, Régis ; Centre Hospitalier Universitaire de Liège - CHU > > Service de diabétologie, nutrition, maladies métaboliques
Rosa, Mário Miguel; Faculty of Medicine, University of Lisboa, Lisbon, Portugal
Thomas, Thierry ; Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France ; INSERM U1059, Université de Lyon, Université Jean Monnet, Saint-Etienne, France
Thomasius, Friederike; Center of Bone Health, Frankfurt, Germany
Vlaskovska, Mila; Medical Faculty, Department of Pharmacology and Toxicology, Medical University Sofia, Sofia, Bulgaria
Rizzoli, René ; Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
Cooper, Cyrus ; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk ; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. cc@mrc.soton.ac.uk ; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk
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