Is a treat-to-target strategy in osteoporosis applicable in clinical practice? consensus among a panel of European experts

Thomas, T.; Casado, E.; Geusens, P.; Lems, W. F.; Timoshanko, J.; Taylor, D.; Hofbauer, L. C.

Affiliations

¹CHU de St-Etienne, INSERM U1059, Université de Lyon, St-Etienne, France

²University Hospital Parc Taulí, Sabadell, Spain

³Maastricht University, Maastricht, The Netherlands

⁴Hasselt University, Hasselt, Belgium

⁵Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands

⁶UCB Pharma, Slough, UK

⁷Ogilvy Health, London, UK

⁸Center for Healthy Aging & Department of Medicine III, Technische Universität Dresden, Dresden, Germany

Abstract and keywords

Summary: A panel of European experts was convened to establish consensus on a treat-to-target strategy in osteoporosis. Panellists agreed that the ultimate goals of treating osteoporosis are recovering pre-fracture functional level and reducing subsequent fracture risk; there was consensus that total hip bone mineral density is currently the most appropriate treatment target in clinical practice.

Introduction: A modified Delphi approach was convened to establish consensus among European experts on best practice management for patients with fragility fractures and whether a treat-to-target (T2T) strategy is applicable in osteoporosis.

Methods: A panel of 12 clinical experts (from eight European countries) voted on 13 final statements relating to a T2T strategy for osteoporosis across three rounds of blinded, remotely conducted electronic surveys (Likert scale: ‘strongly disagree’, ‘disagree’, ‘unable to answer’, ‘agree’, ‘strongly agree’). When panellists disagreed, they were asked how the statement could be adjusted to allow for a positive response, which was used to refine the statement for the following round. Consensus was defined as ≥ 75% agreement with a statement. Panellists were selected by UCB Pharma, which provided financial and logistical support.

Results: Consensus was reached for 13/13 statements. Panellists agreed that the most important goals for fragility fracture patients are recovery of pre-fracture functional level and reduction of subsequent fracture risk. There was also consensus that a T2T strategy is applicable to osteoporosis and that bone mineral density (BMD) is currently the most clinically appropriate target. With regard to the definition of a specific BMD treatment target and timeframes applicable to T2T in osteoporosis, no clear consensus was reached; panellists emphasised that these would need to be individually determined.

Conclusions: According to a panel of European experts, the main goals of fracture management are to recover pre-fracture functional level and reduce fracture risk. Total hip BMD seems to be the most clinically appropriate treatment target within a T2T strategy.

Keywords: Bone mineral density; Delphi panel; Fragility fracture; Osteoporosis; Treat-to-target

Links

DOI: 10.1007/s00198-020-05569-9

PubMed: 32767094

WoS: 000557134200002

History

Received: 2019-12-13

Accepted: 2020-07-24

Online: 2020-08-07

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Cited By (3)

Year	Entry
2021	Unim B, Minelli G, Da Cas R, Manno V, Trotta F, Palmieri L, Galluzzo L, Maggi S, Onder G. Trends in hip and distal femoral fracture rates in Italy from 2007 to 2017. Bone. January 2021;142:115752.
2022	Banefelt J, Timoshanko J, Söreskog E, Ortsäter G, Moayyeri A, Åkesson KE, Spångéus A, Libanati C. Total hip bone mineral density as an indicator of fracture risk in bisphosphonate-treated patients in a real-world setting. J Bone Miner Res. January 2022;37(1):52-58.
2020	Cundy T. Treat-to-target: mainstream or marketing? Osteoporos Int. October 2020;31(10):1835-1836.