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Management of patients at very high risk of osteoporotic fractures through sequential treatments

Management of patients at very high risk of osteoporotic fractures through sequential treatments
Management of patients at very high risk of osteoporotic fractures through sequential treatments

Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an “anabolic first” approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon.

Anabolic, Antiresorptive, Epidemiology, Fracture, Imminent, Osteoporosis
1594-0667
695-714
Curtis, Elizabeth M.
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Reginster, Jean-Yves
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Al-Daghri, Nasser M.
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Biver, Emmanuel
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Brandi, Maria-Luisa
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Cavalier, Etienne
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Hadji, Peyman
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Halbout, Philippe
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Harvey, Nicholas C.
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Hiligsmann, Mickaël
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Javaid, M. Kassim
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Kanis, J.A,
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Kaufman, Jean-Marc
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Lamy, Olivier
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Matijevic, Radmila
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Diez-Perez, Adolfo
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Rademecker, Regis Pierre
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Rosa, Mario Miguel
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Thomas, Thierry
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Thomasius, Friederike
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Vlaskovska, Mila
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Rizzoli, Rene
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Cooper, Cyrus
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Curtis, Elizabeth M.
12aba0c3-1e9e-49ef-a7e9-3247e649cdd6
Reginster, Jean-Yves
08b05e27-73dd-4ce9-90e5-d64ec922147a
Al-Daghri, Nasser M.
0bf1023c-a104-4f74-8b06-87780dfbd8b4
Biver, Emmanuel
b42930f5-09e2-4548-9520-f8a4b6f2323a
Brandi, Maria-Luisa
2187a1ba-3c5b-4f45-803f-ba5da49af629
Cavalier, Etienne
57553da5-0d77-40a8-bfc2-27ce05eb84e0
Hadji, Peyman
c5aeb754-e076-46ff-8379-8ee377dd0b4b
Halbout, Philippe
a6bac6c8-e463-4c0d-bb75-389ad2b0b945
Harvey, Nicholas C.
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Hiligsmann, Mickaël
120a5b99-2a0a-4a17-99d1-c0e5147d4f59
Javaid, M. Kassim
64155236-2ef0-4065-b684-cf723a888117
Kanis, J.A,
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Kaufman, Jean-Marc
b79b47cd-16f0-4619-bf7c-fb77b115d2cd
Lamy, Olivier
39062e15-cdda-41a2-bf58-ca696c122291
Matijevic, Radmila
665fb578-0e16-45d4-bad0-92b61db65e2d
Diez-Perez, Adolfo
8161a0ff-36d3-4a32-9e06-9f119b59b492
Rademecker, Regis Pierre
0a75e3cf-a282-4ab4-a1c9-f93ee0c4cf32
Rosa, Mario Miguel
4b531345-d8ab-4749-9a06-bbcd8ea4f94d
Thomas, Thierry
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Thomasius, Friederike
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Vlaskovska, Mila
502544a0-c942-466a-a73a-f0019ce89c6f
Rizzoli, Rene
682e7962-68b1-469e-8049-754ad7892221
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6

Curtis, Elizabeth M., Reginster, Jean-Yves, Al-Daghri, Nasser M., Biver, Emmanuel, Brandi, Maria-Luisa, Cavalier, Etienne, Hadji, Peyman, Halbout, Philippe, Harvey, Nicholas C., Hiligsmann, Mickaël, Javaid, M. Kassim, Kanis, J.A,, Kaufman, Jean-Marc, Lamy, Olivier, Matijevic, Radmila, Diez-Perez, Adolfo, Rademecker, Regis Pierre, Rosa, Mario Miguel, Thomas, Thierry, Thomasius, Friederike, Vlaskovska, Mila, Rizzoli, Rene and Cooper, Cyrus (2022) Management of patients at very high risk of osteoporotic fractures through sequential treatments. Aging Clinical and Experimental Research, 34 (4), 695-714. (doi:10.1007/s40520-022-02100-4).

Record type: Review

Abstract

Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an “anabolic first” approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon.

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Accepted/In Press date: 18 February 2022
e-pub ahead of print date: 24 March 2022
Published date: April 2022
Additional Information: Funding Information: The ESCEO Working Group was funded by the ESCEO. The ESCEO receives unrestricted educational grants to support its educational and scientific activities from non-governmental organisations, not-for-profit organisations, non-commercial or corporate partners. The choice of topics, participants, content and agenda of the Working Groups as well as the writing, editing, submission and reviewing of the manuscript are the sole responsibility of the ESCEO, without any influence from third parties. Funding Information: E.M.C. reports lecture fees and travel support from Eli Lilly, Pfizer and UCB, outside the submitted work. N.A.D. reports no conflict of interest. E.B. reports lecture fees from Amgen, outside the submitted work. M.L.B. reports honoraria from Amgen, Bruno Farmaceutici, Calcilytix, Kyowa Kirin, UCB, grants or speaker fees from Abiogen, Alexion, Amgen, Bruno Farmaceutici, Echolight, Eli Lilly, Kyowa Kirin, SPA, Theramex, UCB and consulting fees from Aboca, Alexion, Amolyt, Bruno Farmaceutici, Calcilytix, Kyowa Kirin, UCB, outside the submitted work. E.C. EC is consultant for DiaSorin, IDS, Fujirebio and Nittobo. P.Hadji. reports personal fees, consultancy, lecture fees and honoraria from AMGEN, Eli Lilly, Fresenius, Gedeon Richter, Hexal, MSD, Novartis, Roche, Stada, Theramex, UCB, outside the submitted work. P. Halbout reports no conflict of interest. N.C.H. reports personal fees, consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, UCB, Kyowa Kirin, Servier, Shire, Consilient Healthcare and Internis Pharma, outside the submitted work. MKJ reports personal fees from Amgen, UCB and Besin Healthcare institutional grant support from Amgen and UCB outside of the submitted work. M.H. has received research grants through institution from Amgen, Radius Health, BD, ViiV Healthcare, lecture fees from Teva and Mylan, and consulting fees from UCB outside the submitted work. M.K.J. reports no conflict of interest. J.A.K.: Nothing to declare. JAK is the architect of FRAX® but has no financial interest. J-M.K. reports no conflict of interest in relation to the submitted work. O.L. reports no conflict of interest. R.M. reports no conflict of interest. A.D-P. reports lecture fees from Eli Lilly, Amgen and Gedeon Richter outside the submitted work. R.P.R.: Nothing to declare for the submitted work. M.R. reports no conflict of interest in relation to the submitted work. T.T. has received consultancy/speaker’s fees from Amgen, Arrow, Biogen, Chugai, Expanscience, Grunenthal, Jansen, LCA, Lilly, MSD, Nordic, Novartis, Pfizer, Sanofi, Thuasne, Theramex, TEVA et UCB and financial support or fees for research activities from: Bone Therapeutics, Chugai, UCB. F.T. reports personal fees, consultancy, lecture fees and honoraria from AMGEN, Fresenius, Gedeon-Richter, Hexal, HOLOGIC, Kyowa-Kirin, Stadapharm, Theramex, UCB, outside the submitted work. M.V. reports no conflict of interest in relation to the submitted work. J.Y.R. has received fees for lectures or advisory boards from IBSA-Genevrier, Mylan, Radius Health, Pierre Fabre, Faes Pharma, Rejuvinate Biomed, Teva, Theramex, Pfizer, Mithra Pharmaceuticals, CNIEL, Dairy Research Council, Nutricia, Danone and Agnovos, and industry grants (all through institution) from IBSA-Genevrier, Mylan, CNIEL, Radius Health and TRB, outside the submitted work. R.R. has received fees for lectures or advisory boards from Abiogen, Amgen, Danone, Echolight, European Milk Forum, Mithra, Nestlé, ObsEva, Pfizer Consumer Health, Radius Health, Rejunevate and Theramex. C.C. reports personal fees from ABBH, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier and Takeda, outside the submitted work. Publisher Copyright: © 2022, The Author(s). © 2022. The Author(s).
Keywords: Anabolic, Antiresorptive, Epidemiology, Fracture, Imminent, Osteoporosis

Identifiers

Local EPrints ID: 456252
URI: http://eprints.soton.ac.uk/id/eprint/456252
ISSN: 1594-0667
PURE UUID: 92de8e72-9f74-4a76-9c4f-f45dcee98d19
ORCID for Elizabeth M. Curtis: ORCID iD orcid.org/0000-0002-5147-0550
ORCID for Nicholas C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 26 Apr 2022 23:30
Last modified: 26 Nov 2022 02:51

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Contributors

Author: Jean-Yves Reginster
Author: Nasser M. Al-Daghri
Author: Emmanuel Biver
Author: Maria-Luisa Brandi
Author: Etienne Cavalier
Author: Peyman Hadji
Author: Philippe Halbout
Author: Mickaël Hiligsmann
Author: M. Kassim Javaid
Author: J.A, Kanis
Author: Jean-Marc Kaufman
Author: Olivier Lamy
Author: Radmila Matijevic
Author: Adolfo Diez-Perez
Author: Regis Pierre Rademecker
Author: Mario Miguel Rosa
Author: Thierry Thomas
Author: Friederike Thomasius
Author: Mila Vlaskovska
Author: Rene Rizzoli
Author: Cyrus Cooper ORCID iD

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