The treatment gap:​ the missed opportunities for osteoporosis therapy

Fuggle, Nicholas R.<sup>1,2</sup>; Curtis, Beth<sup>1,2</sup>; Clynes, Michael<sup>1,2</sup>; Zhang, Jean<sup>1,2</sup>; Ward, Kate<sup>1,3</sup>; Javaid, Muhammad Kassim<sup>1,4</sup>; Harvey, Nicholas C.<sup>1,2,3</sup>; Dennison, Elaine<sup>1,2,3</sup>; Cooper, Cyrus<sup>1,2,3,4</sup>

Affiliations

¹ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK

²Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK

³NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK

⁴NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK

Abstract and keywords

Despite substantial advances in delineation of the epidemiology, pathophysiology, risk assessment and treatment of osteoporosis over the last three decades, a substantial proportion of men and women at high risk of fracture remain untreated - the so-called “treatment gap”. This review summarises the important patient-, physician- and policyrelated causes of this treatment gap, before discussing in greater detail: (a) the evidence base for the efficacy of bisphosphonates in osteoporosis; (b) recent evidence relating to the adverse effects of this widely used therapeutic class, most notably atypical femoral fracture and osteonecrosis of the jaw; (c) available strategies to improve both secondary and primary prevention pathways for the management of this disorder.

Keywords: Osteoporosis; Bisphosphonates; Treatment gap

Links

DOI: 10.1016/j.bone.2020.115833

PubMed: 33359891

WoS: 000615746400011

History

Received: 2020-04-23

Revised: 2020-12-19

Accepted: 2020-12-19

Online: 2020-12-23

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Cited By (2)

Year	Entry
2022	Ralston KAP, Hauser B, Paskins Z, Ralston SH. Effective communication and the osteoporosis care gap. J Bone Miner Res. November 2022;37(11):2049-2054.
2023	Kline GA, Morin SN, Lix LM, Leslie WD. A population-based registry study of extended bisphosphonate use: minimal shift after landmark publications about shorter treatment duration. J Bone Miner Res. October 2023;38(10):1435-1442.