Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

Kanis, John А.; Harvey, Nicholas C.; McCloskey, Eugène; Bruyère, Olivier; Veronese, Nicola; Lorentzon, Mattias; Cooper, Cyrus; Rizzoli, René; Adib, Gemma; Al-Daghri, Nasser M.; Campusano, Claudia; Chandran, Manju; Dawson‐Hughes, Bess; Javaid, K; Jiwa, Famida; Johansson, Helena; Lee, J.K; Liu, Enwu; Messina, D.; Mkinsi, Ouafa; Pinto, Daniel; Prieto‐Alhambra, Daniel; Saag, Kenneth G.; Xia, Weibo; Zakraoui, L.; Reginster, Jean‐Yves

doi:10.1007/s00198-019-05176-3

Cited by 258 publications

(269 citation statements)

References 63 publications

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“…There were small variations in the percentage increase in cost by country. The greater increases were noted in Spain Table 3 Ten-year probability of a major osteoporotic fracture (MOF) for Icelandic women at different ages, categorized by previous fracture [32] 10-year probability of MOF [38] (+30.6%), the UK (+30.2) and Sweden (+29.4%) and lower increments in Germany (+23.2%), Italy (+26.2%) and France (+26.4%).…”

Section: Annual Fracture-related Costsmentioning

confidence: 99%

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Fragility fractures in Europe: burden, management and opportunities

et al. 2020

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This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years. Introduction Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6). Methods A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric. Results Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided. Conclusions Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.

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Section: Annual Fracture-related Costsmentioning

confidence: 99%

“…Ten-year probability of a major osteoporotic fracture (MOF) in women with a prior clinical vertebral fracture at an undetermined time and within the past two years according to country. Age set to 60 years, BMI 25 kg/m 2 , no additional risk factors[32] …”

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confidence: 99%

Fragility fractures in Europe: burden, management and opportunities

et al. 2020

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“…Patients with lower or moderate fracture risk can be started on oral agents. Patients with gastrointestinal problems that might not absorb oral medications should take injectable agents such as denosumab or zoledronic acid [128]. Denosumab is a human monoclonal antibody that prevents receptor activator of nuclear factor kappa-B ligand (RANKL) from binding to its receptor, RANK, thereby reducing the differentiation of precursor cells into mature osteoclasts and decreasing the function and survival of activated osteoclasts.…”

Section: Clinical Management Of Bone Health and Vitamin D Supplementamentioning

confidence: 99%

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

Altieri¹,

Dato

Modica

et al. 2020

Nutrients

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Patients affected by gastroenteropancreatic–neuroendocrine tumors (GEP–NETs) have an increased risk of developing osteopenia and osteoporosis, as several factors impact on bone metabolism in these patients. In fact, besides the direct effect of bone metastasis, bone health can be affected by hormone hypersecretion (including serotonin, cortisol, and parathyroid hormone-related protein), specific microRNAs, nutritional status (which in turn could be affected by medical and surgical treatments), and vitamin D deficiency. In patients with multiple endocrine neoplasia type 1 (MEN1), a hereditary syndrome associated with NET occurrence, bone damage may carry other consequences. Osteoporosis may negatively impact on the quality of life of these patients and can increment the cost of medical care since these patients usually live with their disease for a long time. However, recommendations suggesting screening to assess bone health in GEP–NET patients are missing. The aim of this review is to critically analyze evidence on the mechanisms that could have a potential impact on bone health in patients affected by GEP–NET, focusing on vitamin D and its role in GEP–NET, as well as on factors associated with MEN1 that could have an impact on bone homeostasis.

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“…These numbers are predicted to arise in the future decades around 2.5-3 times in both the male and female populations, making not only osteoporosis but the musculoskeletal diseases an emerging global health and economic burden. 11,12 According to a current experts' point of view published by Kanis et al 13 for the diagnosis of osteoporosis the measurement by dual X-ray absorptiometry (DXA) of bone mineral density (BMD) remains the golden standard. Bone turnover markers (BTMs) might have some prognostic value for the assessment of fragility fractures, when BMD measurements are unavailable.…”

Section: Introductionmentioning

confidence: 99%

<p>Soluble Biomarkers of Osteoporosis and Osteoarthritis, from Pathway Mapping to Clinical Trials: An Update</p>

Nagy

Nagy-Finna

Popoviciu

et al. 2020

CIA

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Serum biomarkers of osteoarticular diseases have been in the limelight of current clinical research trends. Laboratory validation of defined and candidate biomarkers for both osteoarthritis and osteoporosis is of key importance for future decisional algorithms in the diagnosis, monitoring, and prognosis of these diseases. The current guidelines recommend the use of collagen degradation remnants, eg, CTX-I and CTX-II, in the complementary diagnosis of both osteoporosis and osteoarthritis. Besides the collagen degradation markers, enzymes that regulate bone and articular metabolism are useful in the clinical evaluation of osteoarticular pathologies. Along these, several other recommended and new nominee molecules have been recently studied. Wnts and Wnt-related molecules have a cardinal role in the bone-joint homeostasis, making them a promising target not only for pharmaceutical modulation, but also to be considered as soluble biomarkers. Sclerostin and dickkopf, two inhibitor molecules of the Wnt/β-catenin signaling, might have a dual role in the assessment of the clinical manifestations of the osteoarticular unit. In osteoarthritis, besides fragments of collagen type II many pathway-related molecules have been studied and proposed for biomarker validation. The most serious limitation is that a significant proportion of studies lack statistical power due to the reduced number of cases enrolled. Serum biomarkers of bone and joint turnover markers represent an encouraging possibility for the diagnosis and prognosis of osteoarticular diseases, although further studies and laboratory validations should be carried out as to solely rely on them.

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Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

Cited by 258 publications

References 63 publications

Fragility fractures in Europe: burden, management and opportunities

Fragility fractures in Europe: burden, management and opportunities

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

<p>Soluble Biomarkers of Osteoporosis and Osteoarthritis, from Pathway Mapping to Clinical Trials: An Update</p>

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