The clinician’s guide to prevention and treatment of osteoporosis

Abstract

Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2-to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF)formerly the National Osteoporosis Foundationfirst published the Clinician's Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician's Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued-sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores * M. S. LeBoff

Serum Insulin-Like Growth Factor 1 Levels, Facture Risk Assessment Tool Scores and Bone Disorders in Patients with Primary Biliary Cholangitis

“…Therefore, it is important to evaluate bone mass and fracture risk and initiate osteoporosis treatment as early as possible to prevent fracture. Recently, several academic societies have addressed or discussed when to initiate osteoporosis treatment using the FRAX [ 12 , 13 ]. Meanwhile, IGF-1 plays a vital role in bone growth and homeostasis, and its decreased levels are associated with bone disorders [ 6 , 14 , 15 , 16 , 17 , 18 ].…”

“…The scoring model comprises the following risk factors for fragility fractures: gender, age, height, weight, previous history of fracture, parental history of HF, current smoking and drinking (≥3 units or 60 g/day), use of glucocorticoid (prednisolone at a dose of >5 mg/day for at least 3 months), presence of RA or diseases related to secondary osteoporosis (including CLD) and femoral neck BMD [ 11 ]. High fracture risk was defined as FRAX-MOF ≥ 20% or FRAX-HF ≥ 3% [ 13 ].…”

“…The European Association for the Study of the Liver’s clinical guidelines for the management of PBC state that therapeutic intervention for osteoporosis should take into account the overall risk of fracture, which can be estimated by the FRAX [ 12 ]. The Bone Health and Osteoporosis Foundation states that pharmacologic treatment should be considered in patients with osteoporosis who have a T-score of ≤−2.5 and those with a reduced bone mass (T-score between −1.0 and −2.5) who have FRAX-MOF or FRAX-HF of ≥20% or ≥3%, respectively [ 13 ].…”

Effects of tele-exercise rehabilitation intervention on women at high risk of osteoporotic fractures: study protocol for a randomised controlled trial

“…Are at high risk of fracture: participants are recognised as having a high risk of fracture if the 10-year probability of a hip fracture is ≥3% or that of a major OP-related fracture (clinical spine, forearm, hip or shoulder fracture) is ≥20% 23 using the Fracture Risk Factor Assessment Tool. 24 …”

Romosozumab for the treatment of osteoporosis in women: Efficacy, safety, and cardiovascular risk

“…Osteoporosis-related fractures are costly and pose economic burdens to the health care system and society. 3 …”