Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs

Abstract

Osteoporosis is a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality is the hallmark of osteoporosis which leads to an increased risk of fragility fractures in elderly. It has been estimated that approximately ~50% of women will suffer during their lifetime from an osteoporotic fracture. This must be considered as a major health concern, as it has previously been established that fragility fracture has been associated with decreased quality of life due to increased disability, more frequent hospital admission and most importantly, osteoporotic fractures have been related to an augmented mortality risk. Anti-osteoporotic drugs are available for improving bone quality. Although there is access to these therapeutic options, there remain multiple unmet needs in the field of osteoporosis and fracture care, for example, the primary prevention of osteoporosis in young individuals (to reach a high peak bone mass), the optimization of the use of imaging techniques [dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA) and new techniques measuring bone quality], the use of nonmedical treatment options and surgical techniques of fracture healing. In this review, we will discuss topics that play a role in the occurrence and prevention of fractures, and we give an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention.

Abaloparatide: an anabolic treatment to reduce fracture risk in postmenopausal women with osteoporosis

“…Osteoporosis, a disorder that often occurs with aging, is associated with reduced bone mass, compromised bone strength, and impaired bone quality, resulting in an increased risk of fracture 1,2 . Postmenopausal women are at particular risk for osteoporosis due to estrogen deficiency, with nearly one in two women likely to experience an osteoporosis-related fracture in their lifetime 3 .…”

Still a Major Concern: Osteoporosis Has a Serious Impact on Quality of Life

“…Reasons for suboptimal fracture prevention are: 1-Fractures do occur, mainly in the elderly, 2-Fear of severe side effects, 3-Lack of education in professionals and in the lay public, 4-Lack of engagement: OP is a low medical priority, 5-Lack of coordination between health care systems, 6-Inadequate access to diagnostics such as BMD measurement and vertebral fracture assessment, 7-Suboptimal predictive value of diagnostic techniques, 8-The treatment gap, 9-Low adherence and compliance to anti-osteoporotic drugs, 10-Generic drugs, nocebo-effect (negative counterpart), 11-Lack of focus on muscle strength and fall prevention (7). As clearly stated bu Lems and Raterman, many other factors play a role, such as; to reach a high peak bone mass for the prevention of OP in young individuals, as well as the optimization of the use of imaging techniques (DXA and Vertebral Fracture Assesment and new techniques to measure the bone quality) and also the use of medical and nonmedical treatment options, and surgical techniques of fracture healing (8).…”

“…3-More adequate measurement of bone strength, 4-Reduction in the treatment gap, 5-New drugs with a better efficacy/safety profile, 6-Shared decision making with optimal nonmedical and medical treatment (Non pharmacological interventions include specific physical exercises for OP to improve muscle strength and balance, decrease pain, and improve QoL). 7-New strategies: treat to target and definition of high-risk patients (8). The cost of these fractures for societies is enormous and is forecast to steadily increase over the coming decades globally.…”

Healthy ageing: the natural consequences of good nutrition—a conference report

“…Seventy-five percent of hip, spine and distal forearm fractures occur among those 65 years or older [ 97 ]. Fragility fractures are associated with decreased quality of life, increased disability, more frequent hospital admission and an increased risk of mortality [ 88 ]. While a multimodal approach is important for fall protection, vitamin D supplementation alone, or in combination with calcium, has been shown to significantly reduce the risk of falling in elders [ 142 ].…”