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The Duration and Safety of Osteoporosis Treatment pp 309–320Cite as

Integrated Clinical View on Long-Term Management of Patients with Osteoporosis

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Abstract

Challenges in the long-term management of osteoporosis include limited time for patient encounters, competing healthcare priorities, under-recognition of patients at high risk for fracture, inaccurate assessment of fracture risk, poor understanding of the balance of benefits and risks with osteoporosis treatment, and poor adherence to therapy. Strategies to reduce the burden of osteoporotic fractures must address these and other challenges, customizing patient care according to clinical circumstances. Treatment decisions should be individualized with consideration of applicable clinical practice guidelines (CPGs) and all available clinical information. When pharmacological therapy is indicated, an initial drug must be chosen, treatment monitored, and decisions made on when, if ever, to withhold or change therapy. Effective risk communication and shared treatment decision-making may improve clinical outcomes. Systems-based methods, such as fracture liaison services (FLSs), may be particularly effective at secondary fracture prevention. Development of osteoporosis treatment targets might improve the care of osteoporosis.

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Notes

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    *Important References

    **Very important References

References

*Important References

**Very important References

  1. Lewiecki EM. Bone density measurement and assessment of fracture risk. Clin Obstet Gynecol. 2013;56(4):667–76.

    Article  PubMed  Google Scholar 

  2. Warriner AH, Saag KG. Osteoporosis diagnosis and medical treatment. Orthop Clin North Am. 2013;44(2):125–35.

    Article  PubMed  Google Scholar 

  3. Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, et al. Under diagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res. 2005;20(4):557–63.

    Article  PubMed  Google Scholar 

  4. Kamel HK, Hussain MS, Tariq S, Perry III HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med. 2000;109(4):326–8.

    Article  PubMed  CAS  Google Scholar 

  5. Curtis JR, McClure LA, Delzell E, Howard VJ, Orwoll E, Saag KG, et al. Population-based fracture risk assessment and osteoporosis treatment disparities by race and gender. J Gen Intern Med. 2009;24(8):956–62.

    Article  PubMed  PubMed Central  Google Scholar 

  6. National Committee for Quality Assurance. Improving quality and patient experience-the state of health care quality; 2013. http://www.ncqa.org/Portals/0/Newsroom/SOHC/2013/SOHC-web%20version%20report.pdf. Accessed 21 Dec 2013.

  7. US Department of Health and Human Services. Bone health and osteoporosis: a report of the surgeon general. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General; 2004.

    Google Scholar 

  8. Strom O, Borgstrom F, Kanis JA, Compston J, Cooper C, McCloskey EV, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the international osteoporosis foundation (IOF) and the European federation of pharmaceutical industry associations (EFPIA). Arch Osteoporos. 2011;6(1–2):59–155.

    Article  PubMed  CAS  Google Scholar 

  9. Curtis JR, Adachi JD, Saag KG. Bridging the osteoporosis quality chasm. J Bone Miner Res. 2009;24(1):3–7.

    Article  PubMed  Google Scholar 

  10. Lewiecki EM. Review of guidelines for bone mineral density testing and treatment of osteoporosis. Curr Osteoporos Rep. 2005;3(3):75–83.

    Article  PubMed  Google Scholar 

  11. Waitzkin H. Doctor-patient communication. Clinical implications of social scientific research. JAMA. 1984;252(17):2441–6.

    Article  PubMed  CAS  Google Scholar 

  12. Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2007;42(5):1871–94.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Braddock 3rd CH, Snyder L. The doctor will see you shortly. The ethical significance of time for the patient-physician relationship. J Gen Intern Med. 2005;20(11):1057–62.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Whitaker M, Guo J, Kehoe T, Benson G. Bisphosphonates for osteoporosis – where do we go from here? N Engl J Med. 2012;366(22):2048–51.

    Article  PubMed  CAS  Google Scholar 

  15. Leslie L, Lix L, Morin S, Majumdar S, Johansson H, McCloskey E, et al. Can changes in FRAX probability be used to “treat-to-target”? A clinical feasibility study. J Bone Miner Res. 2013;28 Suppl 1:S157.

    Google Scholar 

  16. Black DM, Bauer DC, Schwartz AV, Cummings SR, Rosen CJ. Continuing bisphosphonate treatment for osteoporosis – for whom and for how long? N Engl J Med. 2012;366(22):2051–3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Gehlbach S, Saag KG, Adachi JD, Hooven FH, Flahive J, Boonen S, et al. Previous fractures at multiple sites increase the risk for subsequent fractures: the global longitudinal study of osteoporosis in women. J Bone Miner Res. 2012;27(3):645–53.

    Article  PubMed  Google Scholar 

  18. van Geel TA, Huntjens KM, van den Bergh JP, Dinant GJ, Geusens PP. Timing of subsequent fractures after an initial fracture. Curr Osteoporos Rep. 2010;8(3):118–22.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gallagher JC, Genant HK, Crans GG, Vargas SJ, Krege JH. Teriparatide reduces the fracture risk associated with increasing number and severity of osteoporotic fractures. J Clin Endocrinol Metab. 2005;90(3):1583–7.

    Article  PubMed  CAS  Google Scholar 

  20. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral fractures but not wrist fractures. J Bone Miner Res. 1999;14:821–8.

    Article  PubMed  CAS  Google Scholar 

  21. Shibli-Rahhal A, Vaughan-Sarrazin MS, Richardson K, Cram P. Testing and treatment for osteoporosis following hip fracture in an integrated U.S. healthcare delivery system. Osteoporos Int. 2011;22(12):2973–80.

    Article  PubMed  CAS  Google Scholar 

  22. **Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, et al. Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24(8):2135–52. **This is an excellent presentation of the concept of a fracture liaison service with advice on how to initiate and maintain it.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Lee DB, Lowden MR, Patmintra V, Stevenson K. National bone health alliance: an innovative public-private partnership improving America’s bone health. Curr Osteoporos Rep. 2013;11(4):348–53.

    Article  PubMed  Google Scholar 

  24. Tosi LL, Gliklich R, Kannan K, Koval KJ. The American orthopaedic association’s “own the bone” initiative to prevent secondary fractures. J Bone Joint Surg Am. 2008;90(1):163–73.

    Article  PubMed  Google Scholar 

  25. Galantino ML, Green L, Decesari JA, Mackain NA, Rinaldi SM, Stevens ME, et al. Safety and feasibility of modified chair-yoga on functional outcome among elderly at risk for falls. Int J Yoga. 2012;5(2):146–50.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lee MS, Ernst E. Systematic reviews of t’ai chi: an overview. Br J Sports Med. 2012;46(10):713–8.

    Article  PubMed  Google Scholar 

  27. Lewiecki EM, Binkley N, Petak SM. DXA quality matters. J Clin Densitom. 2006;9(4):388–92.

    Article  PubMed  Google Scholar 

  28. **Schousboe JT, Shepherd JA, Bilezikian JP, Baim S. Executive summary of the 2013 international society for clinical densitometry position development conference on bone densitometry. J Clin Densitom. 2013;16(4):455–66. **The ISCD Official Positions provide standards for quality control, acquisition, analysis, and interpretation of bone density tests.

    Article  PubMed  Google Scholar 

  29. *Lewiecki EM, Miller PD, Harris ST, Bauer DC, Davison KS, Dian L, et al. Understanding and communicating the benefits and risks of denosumab, raloxifene, and teriparatide for the treatment of osteoporosis. J Clin Densitom. 2014;17(4):490–5. *This is a review of the balance of benefits and risks of non-bisphosphonate therapies for osteoporosis.

    Google Scholar 

  30. *McClung M, Harris ST, Miller PD, Bauer DC, Davison KS, Dian L, et al. Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med. 2013;126(1):13–20. *This is a review of the balance of benefits and risks of bisphosphonate therapies for osteoporosis.

    Article  PubMed  CAS  Google Scholar 

  31. Radonich M. Communicating radiation risk to the public. In: Community environmental monitoring program 25th anniversary annual workshop (Internet); 2006. http://www.cemp.dri.edu/cemp/workshop2006/presentations/Radonich-Communicating_Radiation_Risk_to_the_Public-Part_1.pdf. Accessed 2 Jan 2014.

  32. Covello VT, Sandman PM. Risk communication: evolution and revolution. The Peter Sandman Risk Communication Website (Internet); 2001. http://www.psandman.com/articles/covello.htm. Accessed 10 Jan 2014.

  33. Edwards A, Elwyn G. How should effectiveness of risk communication to aid patients’ decisions be judged? A review of the literature. Med Decis Making. 1999;19(4):428–34.

    Article  PubMed  CAS  Google Scholar 

  34. Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, et al. Interpretation and use of FRAX in clinical practice. Osteoporos Int. 2011;22(9):2395–411.

    Article  PubMed  CAS  Google Scholar 

  35. World Health Organization. FRAX WHO fracture risk assessment tool. World Health Organization (Internet); 2012. http://www.shef.ac.uk/FRAX/. Accessed 17 Sept 2012.

  36. Cohen JT, Neumann PJ. What’s more dangerous, your aspirin or your car? Thinking rationally about drug risks (and benefits). Health Aff (Millwood). 2007;26(3):636–46.

    Article  Google Scholar 

  37. Grey A, Bolland MJ. The effect of treatments for osteoporosis on mortality. Osteoporos Int. 2013;24(1):1–6.

    Article  PubMed  CAS  Google Scholar 

  38. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American society for bone and mineral research. J Bone Miner Res. 2007;22(10):1479–89.

    Article  PubMed  Google Scholar 

  39. Dowd R, Recker RR, Heaney RP. Study subjects and ordinary patients. Osteoporos Int. 2014;17(4):490–5.

    Google Scholar 

  40. O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009;3:CD001431.

    PubMed  Google Scholar 

  41. Meyer G, Steckelberg A, Muhlhauser I. Analysis of consumer information brochures on osteoporosis prevention and treatment. Ger Med Sci. 2007;5:1–9.

    Google Scholar 

  42. Lewiecki EM, Rudolph LA, Kiebzak GM, Chavez JR, Thorpe BM. Assessment of osteoporosis-website quality. Osteoporos Int. 2006;17(5):741–52.

    Article  PubMed  CAS  Google Scholar 

  43. Ancker JS, Senathirajah Y, Kukafka R, Starren JB. Design features of graphs in health risk communication: a systematic review. J Am Med Inform Assoc. 2006;13(6):608–18.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Schapira MM, Nattinger AB, McHorney CA. Frequency or probability? A qualitative study of risk communication formats used in health care. Med Decis Making. 2001;21(6):459–67.

    Article  PubMed  CAS  Google Scholar 

  45. Montori VM, Shah ND, Pencille LJ, Branda ME, Van Houten HK, Swiglo BA, et al. Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial. Am J Med. 2011;124(6):549–56.

    Article  PubMed  Google Scholar 

  46. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49(5):651–61.

    Article  PubMed  CAS  Google Scholar 

  47. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92.

    Article  PubMed  CAS  Google Scholar 

  48. Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566–77.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Loh A, Leonhart R, Wills CE, Simon D, Harter M. The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Couns. 2007;65(1):69–78.

    Article  PubMed  Google Scholar 

  50. *Lewiecki EM. Risk communication and shared decision making in the care of patients with osteoporosis. J Clin Densitom. 2010;13(4):335–45. *Strategies for applying effective risk communication and shared decision making in the care of osteoporosis are reviewed here.

    Article  PubMed  Google Scholar 

  51. Dwamena F, Holmes-Rovner M, Gaulden CM, Jorgenson S, Sadigh G, Sikorskii A, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2012;12:CD003267.

    PubMed  Google Scholar 

  52. National Research Council. Clinical practice guidelines: directions for a new program. In: Field J, Lohr K, editors. Committee to advise the public health service on clinical practice. Washington, DC: The National Academies Press; 1990.

    Google Scholar 

  53. Hayward RS, Wilson MC, Tunis SR, Bass EB, Guyatt G. Users’ guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? The evidence-based medicine working group. JAMA. 1995;274(7):570–4.

    Article  PubMed  CAS  Google Scholar 

  54. O’Brien Jr JA, Jacobs LM, Pierce D. Clinical practice guidelines and the cost of care. A growing alliance. Int J Technol Assess Health Care. 2000;16(4):1077–91.

    Article  PubMed  Google Scholar 

  55. Nair R, Aggarwal R, Khanna D. Methods of formal consensus in classification/diagnostic criteria and guideline development. Semin Arthritis Rheum. 2011;41(2):95–105.

    Article  PubMed  PubMed Central  Google Scholar 

  56. *Lewiecki EM, Binkley N. Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis. Endocr Pract. 2009;24(10):1643–6. *This describes the benefits and limitations of evidence-based medicine and clinical practice guidelines in the care of individual patients with osteoporosis.

    Google Scholar 

  57. Swiglo BA, Murad MH, Schunemann HJ, Kunz R, Vigersky RA, Guyatt GH, et al. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab. 2008;93(3):666–73.

    Article  PubMed  CAS  Google Scholar 

  58. Clowes JA, Peel NF, Eastell R. The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab. 2004;89(3):1117–23.

    Article  PubMed  CAS  Google Scholar 

  59. Lewiecki EM, Watts NB. Assessing response to osteoporosis therapy. Osteoporos Int. 2008;19(10):1363–8.

    Article  PubMed  CAS  Google Scholar 

  60. Imaz I, Zegarra P, Gonzalez-Enriquez J, Rubio B, Alcazar R, Amate JM. Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis. Osteoporos Int. 2010;21(11):1943–51.

    Article  PubMed  CAS  Google Scholar 

  61. Siris ES, Selby PL, Saag KG, Borgstrom F, Herings RM, Silverman SL. Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med. 2009;122 Suppl 2:S3–13.

    Article  PubMed  Google Scholar 

  62. Hiligsmann M, Salas M, Hughes DA, Manias E, Gwadry-Sridhar FH, Linck P, et al. Interventions to improve osteoporosis medication adherence and persistence: a systematic review and literature appraisal by the ISPOR medication adherence & persistence special interest group. Osteoporos Int. 2013;24(12):2907–18.

    Article  PubMed  CAS  Google Scholar 

  63. Lewiecki EM, Cummings SR, Cosman F. Treat-to-target for osteoporosis: is now the time? J Clin Endocrinol Metab. 2013;98(3):946–53.

    Article  PubMed  CAS  Google Scholar 

  64. Cummings SR, Cosman F, Eastell R, Reid IR, Mehta M, Lewiecki EM. Goal-directed treatment of osteoporosis. J Bone Miner Res. 2013;28(3):433–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. New Mexico Clinical Research and Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA

    E. Michael Lewiecki MD

  2. Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA

    E. Michael Lewiecki MD

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Correspondence to E. Michael Lewiecki MD .

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Editors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center; University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA

    Stuart Silverman

  2. Institute of Clinical Research; Department of Medicine, Holbæk, Denmark, University of Southern Denmark, Odense Patient Data Explorative Network; Holbæk Hospital, Odense, Denmark

    Bo Abrahamsen

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Lewiecki, E.M. (2016). Integrated Clinical View on Long-Term Management of Patients with Osteoporosis. In: Silverman, S., Abrahamsen, B. (eds) The Duration and Safety of Osteoporosis Treatment. Springer, Cham. https://doi.org/10.1007/978-3-319-23639-1_22

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  • DOI: https://doi.org/10.1007/978-3-319-23639-1_22

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