Management of Patients with Increased Fracture Risk

  • Felicia Cosman


Osteoporosis is often diagnosed in women and men in the sixth decade of life, resulting in up to 40 years during which bone loss progresses and fracture risk increases. Therefore, treatment decisions for osteoporosis should consider not just whether to treat but also what is the most rational approach to long-term control of the disease, with the goals of minimizing fracture risk while also minimizing risk of adverse events. Different medications are more appropriate at different ages and severity of the disease. Furthermore, proof of efficacy for any therapy beyond 5 years is limited, and some adverse events with potent anti-resorptive medication might be associated with duration of treatment. No osteoporosis medication should be used forever, and sequential monotherapy, rotating effective agents, is the most logical approach for most individuals. This chapter provides a rationale for treatment decisions at different ages and stages of osteoporosis and discusses treatment sequences that are most likely to achieve the greatest therapeutic margin. The chapter will also cover a rationale for consideration of stopping therapy (and how to determine when and if to restart therapy). Finally, the chapter discusses the circumstances in which combination therapy should be considered.


Fracture risk Osteoporosis Anti-resorptive medication Sequential monotherapy Drug holiday Treatment duration Bone mineral density 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Helen Hayes HospitalWest HaverstrawUSA

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