The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis

Kanis, John А.; McCloskey, Eugène; Harvey, Nicholas C; Cooper, Cyrus; Rizzoli, René; Dawson‐Hughes, Bess; Maggi, Stefania; Reginster, Jean‐Yves

doi:10.1007/s00198-022-06567-9

Cited by 20 publications

(22 citation statements)

References 82 publications

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“…Following calls to change the definition of osteoporosis [ 1 , 2 ], a position paper of the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) recently addressed the rationale for separate diagnostic and intervention thresholds in osteoporosis [ 3 ]. The conclusions of the working group are given below.…”

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Intervention thresholds and diagnostic thresholds in the management of osteoporosis

et al. 2022

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Intervention thresholds and diagnostic thresholds in the management of osteoporosis

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“…In the context of assessing osteoporotic fracture risk, an individual’s bone phenotype is reduced to a singular trait: aBMD measured by DXA. Areal BMD has a high specificity to predict fractures, meaning that individuals with exceptionally low bone mass (i.e., a T -score ≤ − 2.5) are identified to have an osteoporotic phenotype and thus have a high risk of fractures [ 92 , 93 ]. In contrast, aBMD has a low sensitivity, meaning that most patients who fracture do not have an osteoporotic phenotype according to the aBMD diagnostic threshold.…”

Section: Clinical Implications Of Skeletal Phenotypesmentioning

confidence: 99%

Characterizing Bone Phenotypes Related to Skeletal Fragility Using Advanced Medical Imaging

Whittier,

Bevers,

Geusens

et al. 2023

Curr Osteoporos Rep

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Purpose of Review Summarize the recent literature that investigates how advanced medical imaging has contributed to our understanding of skeletal phenotypes and fracture risk across the lifespan. Recent Findings Characterization of bone phenotypes on the macro-scale using advanced imaging has shown that while wide bones are generally stronger than narrow bones, they may be more susceptible to age-related declines in bone strength. On the micro-scale, HR-pQCT has been used to identify bone microarchitecture phenotypes that improve stratification of fracture risk based on phenotype-specific risk factors. Adolescence is a key phase for bone development, with distinct sex-specific growth patterns and significant within-sex bone property variability. However, longitudinal studies are needed to evaluate how early skeletal growth impacts adult bone phenotypes and fracture risk. Metabolic and rare bone diseases amplify fracture risk, but the interplay between bone phenotypes and disease remains unclear. Although bone phenotyping is a promising approach to improve fracture risk assessment, the clinical availability of advanced imaging is still limited. Consequently, alternative strategies for assessing and managing fracture risk include vertebral fracture assessment from clinically available medical imaging modalities/techniques or from fracture risk assessment tools based on clinical risk factors. Summary Bone fragility is not solely determined by its density but by a combination of bone geometry, distribution of bone mass, microarchitecture, and the intrinsic material properties of bone tissue. As such, different individuals can exhibit distinct bone phenotypes, which may predispose them to be more vulnerable or resilient to certain perturbations that influence bone strength.

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“…[ 2 ] Currently, BMD-based diagnostic criteria for OP remain important. [ 3 ] Osteoporosis is one of the main clinical, social, economic health issues worldwide. [ 4 ] Currently and in the future, OP-related fractures are expected to increase gradually in the aging population of industrialized countries, leading to increased medical and socioeconomic burden on the countries.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, patient selection should be based on the fracture risk considering a combination of clinical risk factors and BMD. [ 3 , 29 , 30 ] Although current evidence-based diagnostic and therapeutic guidelines differ slightly from country to country, pharmacological treatment is indicated if postmenopausal women and men aged ≥50 years have the following characteristics:[ 10 , 16 , 21 , 31 ]…”

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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The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis

Cited by 20 publications

References 82 publications

Intervention thresholds and diagnostic thresholds in the management of osteoporosis

Intervention thresholds and diagnostic thresholds in the management of osteoporosis

Characterizing Bone Phenotypes Related to Skeletal Fragility Using Advanced Medical Imaging

Osteoporosis: Spotlight on current approaches to pharmacological treatment

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