Operationalizing Treat-to-Target for Osteoporosis

Lewiecki, E. Michael

doi:10.3803/enm.2021.970

Cited by 6 publications

(2 citation statements)

References 45 publications

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“…Thus, when confronted with highly discordant measurements (lumbar spine worse than femoral neck) in patients aged 7 to 80 years, clinicians should be alerted of the risk of OVCF and focused on lowering offset between the lumbar spine and femoral neck. [ 28 ]…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of T-Score Spine-Hip Discordance in Patients with Osteoporotic Vertebral Compression Fracture

Yoon¹,

Kang²,

Kim

et al. 2022

J Bone Metab

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Background: T-score discordance between the spine and hip is commonly observed when dual energy X-ray absorptiometry (DXA) is used to diagnose osteoporosis. However, information is scarce regarding the prevalence and risk factors for this problem in Korea. This study evaluated the prevalence of major/minor discordance and associated risk factors in elderly Korean patients with osteoporotic vertebral compression fractures (OVCFs).Methods: This study included 200 patients (37 men, 163 women) treated for thoracic or lumbar compression fractures between January 2015 and August 2021. DXA was performed to examine T‐scores and determine the prevalence of discordance, defined as a difference between the T-score categories of the femur and spine in the same individual. The t-tests, χ2 tests, and regression analyses were used to assess the associated risk factors of T-score discordance among the subjects.Results: T-score concordance, minor discordance, and major discordance were observed in 137 (68.5%), 59 (29.5%), and 4 (2%) patients with OVCFs, respectively. The spinal T-score was lower than the femoral T-score in all major discordance and 81.3% (48/59) of minor discordant cases. Overall, the only factor related to T-score discordance was the age at fracture (odds ratio, -0.01; P=0.014).Conclusions: The results of this study showed that a significant number of subjects (31.5%) showed spine-hip discordance, even with a mean age in their 80s. More attention should be paid to the appropriate evaluation and management of elderly patients with OVCFs. Moreover, a longitudinal study is necessary to verify the clinical importance of T-score discordance in this population.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of T-Score Spine-Hip Discordance in Patients with Osteoporotic Vertebral Compression Fracture

Yoon¹,

Kang²,

Kim

et al. 2022

J Bone Metab

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“…The main goals of targeted treatment in OP are to tailor treatment according to the risk of fracture, to reduce the risk of treatment-related side effects, and to improve adherence to treatment. [ 27 ] Initial treatment is chosen as monotherapy or combined therapy to achieve the goal. The decision on how long to continue treatment, switch or discontinue treatment is made according to the progress toward the goal.…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis: Spotlight on current approaches to pharmacological treatment

Sindel

2023

Turk J Phys Med Rehab

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Despite the availability of safe and effective anti-osteoporosis treatments, osteoporosis continues to be undertreated. The increase in fragility fractures, which is the main clinical consequence of osteoporosis, is a major problem for healthcare systems of countries. A broad range of drugs including antiresorptive and anabolic agents are used in the pharmacological treatment of osteoporosis. Fracture risk assessment in drug selection is of utmost importance in terms of guiding treatment. The recommended thresholds for osteoporosis treatment decision making are based on major osteoporotic and hip fracture probabilities from the Fracture Risk Assessment Tool (FRAX®). Currently, antiresorptive agents are usually the first choice to increase bone mineral density (BMD) and reduce the fracture risk. Bisphosphonates and antiresorptive drugs such as denosumab, a nuclear factor kappa-B ligand (RANKL) inhibitor, are the most widely used drugs in the treatment of osteoporosis. Bisphosphonates alone are unlikely to provide long-term protection against fracture and restore BMD in patients with severe osteoporosis and high fracture risk. In such patients, treatment with an anabolic agent such as teriparatide, abaloparatide, or romosozumab should be ideally initiated to achieve maximal gain in bone mass and preserve the microarchitecture. Ideally, an antiresorptive drug should be continued to maintain gain in bone mass.

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