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

J A Kanis; N C Harvey; E McCloskey; O Bruyère; N Veronese; M Lorentzon; C Cooper; R Rizzoli; G Adib; N Al-Daghri; C Campusano; M Chandran; B Dawson-Hughes; K Javaid; F Jiwa; H Johansson; J K Lee; E Liu; D Messina; O Mkinsi; D Pinto; D Prieto-Alhambra; K Saag; W Xia; L Zakraoui; J -Y Reginster

doi:10.1007/s00198-019-05176-3

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

Osteoporos Int. 2020 Jan;31(1):1-12. doi: 10.1007/s00198-019-05176-3. Epub 2019 Nov 13.

Authors

J A Kanis^{1

2}, N C Harvey³, E McCloskey^{4

5}, O Bruyère⁶, N Veronese⁷, M Lorentzon^{8

9

10}, C Cooper^{3

11}, R Rizzoli¹², G Adib¹³, N Al-Daghri¹⁴, C Campusano¹⁵, M Chandran¹⁶, B Dawson-Hughes¹⁷, K Javaid¹¹, F Jiwa¹⁸, H Johansson^{4

8}, J K Lee¹⁹, E Liu⁸, D Messina²⁰, O Mkinsi²¹, D Pinto^{22

23}, D Prieto-Alhambra^{11

24}, K Saag²⁵, W Xia²⁶, L Zakraoui²⁷, J -Y Reginster^{14

28}

Affiliations

¹ Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, S10 2RX, Sheffield, UK. w.j.Pontefract@shef.ac.uk.
² Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia. w.j.Pontefract@shef.ac.uk.
³ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
⁴ Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, S10 2RX, Sheffield, UK.
⁵ MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing Mellanby, Sheffield, UK.
⁶ World 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.
⁷ National Research Council, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128, Padova, Italy.
⁸ Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia.
⁹ Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹⁰ Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹¹ NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
¹² Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
¹³ Syrian National Osteoporosis Society, Damascus, Syria.
¹⁴ Chair for Biomarkers of Chronic Diseases, Biochemistry Dept., College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
¹⁵ Clinica Universidad de los Andes and Faculty of Medicine, Universidad de los Andes, Santiago, Chile.
¹⁶ Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, 20, College Road, Singapore, 169856, Singapore.
¹⁷ Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
¹⁸ Chair of the Committee of Patients Societies at the International Osteoporosis Foundation, Osteoporosis Canada, Toronto, Canada.
¹⁹ Beacon International Specialist Centre, Petaling Jaya, Malaysia.
²⁰ IRO Medical Research Center, Buenos Aires and Rheumatology section, Cosme Argerich, Buenos Aires, Argentina.
²¹ Department of Rheumatology, Ibn Rochd University Hospital, Casablanca, Morocco.
²² Department of Physical Therapy, Marquette University, Milwaukee, WI, USA.
²³ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
²⁴ GREMPAL Research Group, CIBERFes and Idiap Jordi Gol, Instituto de Salud Carlos III and Universitat Autonoma de Barcelona, Barcelona, Spain.
²⁵ University of Alabama at Birmingham, Birmingham, AL, USA.
²⁶ Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China.
²⁷ Service de Rhumatologie, University Tunis Manar and Hôpital Mongi-Slim, la Marsa, Tunisia.
²⁸ Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.

Abstract

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; FRAX; Fracture risk assessment; Inhibitors of bone resorption; Treatment of osteoporosis.

MeSH terms

Aged
Algorithms*
Bone Density
Female
Humans
Middle Aged
Osteoporosis, Postmenopausal* / complications
Osteoporosis, Postmenopausal* / drug therapy
Osteoporosis, Postmenopausal* / epidemiology
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / etiology
Osteoporotic Fractures* / prevention & control
Risk Assessment
Risk Factors

Abstract

MeSH terms

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