Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

Kanis, J. A.<sup>1,2</sup>; Harvey, N. C.<sup>3</sup>; McCloskey, E.<sup>1,4</sup>; Bruyère, O.<sup>5</sup>; Veronese, N.<sup>6</sup>; Lorentzon, M.<sup>2,7,8</sup>; Cooper, C.<sup>3,9</sup>; Rizzoli, R.<sup>10</sup>; Adib, G.<sup>11</sup>; Al-Daghri, N.<sup>12</sup>; Campusano, C.<sup>13</sup>; Chandran, M.<sup>14</sup>; Dawson-Hughes, B.<sup>15</sup>; Javaid, K.<sup>9</sup>; Jiwa, F.<sup>16</sup>; Johansson, H.<sup>1,2</sup>; Lee, J. K.<sup>17</sup>; Liu, E.<sup>2</sup>; Messina, D.<sup>18</sup>; Mkinsi, O.<sup>19</sup>; Pinto, D.<sup>20,21</sup>; Prieto-Alhambra, D.<sup>9,22</sup>; Saag, K.<sup>23</sup>; Xia, W.<sup>24</sup>; Zakraoui, L.<sup>25</sup>; Reginster, J.-Y.<sup>12,26</sup>

Affiliations

¹Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

²Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia

³MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

⁴MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing Mellanby, Sheffield, UK

⁵World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium

⁶National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy

⁷Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

⁸Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden

⁹NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK

¹⁰Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

¹¹Syrian National Osteoporosis Society, Damascus, Syria

¹²Chair for Biomarkers of Chronic Diseases, Biochemistry Dept., College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia

¹³Clinica Universidad de los Andes and Faculty of Medicine, Universidad de los Andes, Santiago, Chile

¹⁴Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, Singapore, Singapore

¹⁵Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, USA

¹⁶Chair of the Committee of Patients Societies at the International Osteoporosis Foundation, Osteoporosis Canada, Toronto, Canada

¹⁷Beacon International Specialist Centre, Petaling Jaya, Malaysia

¹⁸IRO Medical Research Center, Buenos Aires and Rheumatology section, Cosme Argerich, Buenos Aires, Argentina

¹⁹Department of Rheumatology, Ibn Rochd University Hospital, Casablanca, Morocco

²⁰Department of Physical Therapy, Marquette University, Milwaukee, USA

²¹Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA

²²GREMPAL Research Group, CIBERFes and Idiap Jordi Gol, Instituto de Salud Carlos III and Universitat Autonoma de Barcelona, Barcelona, Spain

²³University of Alabama at Birmingham, Birmingham, USA

²⁴Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

²⁵Service de Rhumatologie, University Tunis Manar and Hôpital Mongi-Slim, la Marsa, Tunisia

²⁶Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium

Abstract and keywords

Summary: Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures.

Introduction: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach.

Methods: Clinical perspective and updated literature search.

Results: The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis.

Conclusions: A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions.

Keywords: Anabolic agents; Fracture risk assessment; FRAX; Inhibitors of bone resorption; Treatment of osteoporosis

Links

DOI: 10.1007/s00198-019-05176-3

PubMed: 31720707

WoS: 000496218000005

History

Received: 2019-06-26

Accepted: 2019-09-18

Online: 2019-11-13

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2021	Schmidutz F, Yan SG, Schopf C, Ihle C, Ahrend M-D, Sprecher CM. Cortical bone thickness predicts the quantitative bone mineral density of the proximal humerus. Arch Osteoporos. December 2021;16(1):33.
2022	Nissen FI, Andreasen C, Borgen TT, Bjørnerem Å, Hansen AK. Cortical bone structure of the proximal femur and incident fractures. Bone. February 2022;155:116284.
2020	Compston JE, Drake MT. Defining very high fracture risk: is FRAX fit for purpose? J Bone Miner Res. August 2020;35(8):1399-1403.
2022	Iconaru L, Charles A, Baleanu F, Surquin M, Benoit F, Mugisha A, Moreau M, Paesmans M, Karmali R, Rubinstein M, Rozenberg S, Body J-J, Bergmann P. Prediction of an imminent fracture after an index fracture: models derived from the Frisbee cohort. J Bone Miner Res. January 2022;37(1):59-67.
2023	Vizcarra P, Moreno A, Vivancos MJ, García AM, Schacke MR, González-Garcia J, Curran A, Palacios R, Guirao AJS, Bañuls SR, Guillén SM, Casado JL; Spanish HIV Research Network (CoRIS). A risk assessment tool for predicting fragility fractures in people with HIV: derivation and internal validation of the FRESIA model. J Bone Miner Res. October 2023;38(10):1443-1452.
2020	Kanis JA, Johansson H, Harvey NC, Gudnason V, Sigurdsson G, Siggeirsdottir K, Lorentzon M, Liu E, Vandenput L, McCloskey EV. Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures. Osteoporos Int. October 2020;31(10):1817-1828.
2020	Body J-J, Marin F, Kendler DL, Zerbini CAF, López-Romero P, Möricke R, Casado E, Fahrleitner-Pammer A, Stepan JJ, Lespessailles E, Minisola S, Geusens P. Efficacy of teriparatide compared with risedronate on FRAX^®-defined major osteoporotic fractures: results of the VERO clinical trial. Osteoporos Int. October 2020;31(10):1935-1942.
2020	Kanis JA, Cooper C, Dawson-Hughes B, Harvey NC, Johansson H, Lorentzon M, McCloskey EV, Reginster J-Y, Rizzoli R; International Osteoporosis Foundation. FRAX and ethnicity. Osteoporos Int. November 2020;31(11):2063-2067.
2021	Sapkota HR, Nune A, Bateman J, Venkatachalam S. A pragmatic proposal for triaging DXA testing during the COVID-19 global pandemic. Osteoporos Int. January 2021;32(1):1-6.
2021	Kanis JA, Johansson H, Harvey NC, Gudnason V, Sigurdsson G, Siggeirsdottir K, Lorentzon M, Liu E, Vandenput L, Leslie WD, McCloskey EV. The use of 2-, 5-, and 10-year probabilities to characterize fracture risk after a recent sentinel fracture. Osteoporos Int. January 2021;32(1):47-54.
2021	Lems WF, Paccou J, Zhang J, Fuggle NR, Chandran M, Harvey NC, Cooper C, Javaid K, Ferrari S, Akesson KE; International Osteoporosis Foundation Fracture Working Group. Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services. Osteoporos Int. March 2021;32(3):399-411.
2021	Söreskog E, Lindberg I, Kanis JA, Åkesson KE, Willems D, Lorentzon M, Ström O, Berling P, Borgström F. Cost-effectiveness of romosozumab for the treatment of postmenopausal women with severe osteoporosis at high risk of fracture in Sweden. Osteoporos Int. March 2021;32(3):585-594.