Goal-directed treatment of osteoporosis in Europe

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Abstract

Summary

Despite the proven predictive ability of bone mineral density, Fracture Risk Assessment Tool (FRAX®), bone turnover markers, and fracture for osteoporotic fracture, their use as targets for treatment of osteoporosis is limited.

Introduction

Treat-to-target is a strategy applied in several fields of medicine and has recently become an area of interest in the management of osteoporosis. Its role in this setting remains controversial. This article was prepared following a European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group meeting convened under the auspices of the International Osteoporosis Foundation (IOF) to discuss the feasibility of applying such a strategy in osteoporosis in Europe.

Methods

Potential targets range from the absence of an incident fracture to fixed levels of bone mineral density (BMD), a desired FRAX® score, a specified level of bone turnover markers or indeed changes in any one or a combination of these parameters.

Results

Despite the proven predictive ability of all of these variables for fracture (particularly BMD and FRAX), their use as targets remains limited due to low sensitivity, the influence of confounders and current lack of evidence that targets can be consistently reached.

Conclusion

ESCEO considers that it is not currently feasible to apply a treat-to-target strategy in osteoporosis, though it did identify a need to continue to improve the targeting of treatment to those at higher risk (target-to-treat strategy) and a number of issues for the research agenda. These include international consensus on intervention thresholds and definition of treatment failure, further exploration of the relationship between fracture and BMD, and FRAX and treatment efficacy and investigation of the potential of short-term targets to improve adherence.

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Acknowledgments

We are grateful to the Committee of Scientific Advisors of the International Osteoporosis Foundation and the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis for their review and endorsement of this paper.

Conflicts of interest

JA Kanis has received consulting fees, advisory board fees, lecture fees and/or grant support from the majority of companies concerned with skeletal metabolism. E McCloskey has received consultancy, lecture fees, research grant support and/or honoraria from Active Signal, Alliance for Better Bone Health, Amgen, Bayer, Consilient Healthcare, GE Lunar, Hologic, Internis Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Servier, Tethys, UCB and Univadis. ML Brandi has received consulting fees, paid advisory boards, lecture fees and/or grant support from Amgen, Eli Lilly, Merck Sharp & Dohme, Novartis, Servier, Spa, Stroder and NPS. E Dennison declares lecture fees from Lilly. S Ferrari has received consulting fees, advisory board fees, lecture fees and/or grant support from Amgen, GSK, MSD, Eli Lilly, Novartis and Bioiberica. J-M Kauffman has received consulting fees, paid advisory boards, lecture fees and/or grant support from Amgen, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Procter & Gamble, Roche, Sanofi Aventis, Servier and Warner Chilcott. S Papapoulos has received consulting/speaking fees from Axsome, Amgen, Eli Lilly, GlaxoSmithKlein, Merck, Novartis and Roche. J-Y Reginster on behalf of the Department of Public Health, Epidemiology and Health Economics of the University of Liège, Liège, Belgium, received consulting fees or paid advisory boards from Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, UCB. Lecture fees when speaking at the invitation of a commercial sponsor: Merck Sharp and Dohme, Lilly, Rottapharm, IBSA, Genevrier, Novartis, Servier, Roche, GlaxoSmithKline, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Theramex, Nycomed, Novo-Nordisk. R Rizzoli received lecture fee and paid advisory boards from Merck Sharp and Dohme, Eli Lilly, Amgen, Servier, Takeda and Danone. JC Branco and JP Devogelaer have no conflict of interest.

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Kanis, J.A., McCloskey, E., Branco, J. et al. Goal-directed treatment of osteoporosis in Europe. Osteoporos Int 25, 2533–2543 (2014). https://doi.org/10.1007/s00198-014-2787-1

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Keywords

  • BMD
  • Bone marker
  • FRAX
  • Management strategy
  • Osteoporosis
  • Target-to-treat
  • Treat-to-target