The webinar, which was held by Dr Eugene McCloskey on February 2nd and whose recording is available online on the dedicated page of the ECTS website, discussed osteoporosis management in patients with high/imminent fracture risk giving a personal, clinician’s point of view. In this article, we will report the most relevant points covered by Dr McCloskey.
In the first part of the talk, the discussion was focused on the parameters used to judge the successful management of osteoporosis. In particular, Dr McCloskey gave the patient’s and clinician’s perspectives, underlining that both converge on the absence of fractures as the main goal. Then, he described the factors that can influence the choice of treatment and the fact that sometimes it is not possible to choose the most effective therapy due to several aspects including the cost of the treatment, prescribing restrictions, past experience, patient’s choice and preference, and also the lack of head-to-head study to prove the superiority of certain drug compared to another. An important aspect discussed was related to “how do we make a treatment choice?” and how to establish the intervention threshold. In this regard, Dr McCloskey described how a fracture risk-based intervention threshold could be more useful compared to one based on BMD, to decide when and how treat patients.
Regarding fracture risk, he discussed the relatively novel concept of ‘very high fracture risk’ showing inclusion criteria established by dedicated guidelines proposed by the National Osteoporosis Guideline Group (NOGG, UK), suggesting that the very high risk of fractures is conferred by the presence of multiple risk factors and it can translate into an ‘imminent risk’ of fracture. Moreover, he showed how the probability ratio of major osteoporotic fractures varies in women in relation to gender, age, and recent fracture site. An important tool shown to assess the intervention threshold is represented by the FRAX and FRAX plus tools, which can calculate the 10-year probability of Major Osteoporotic Fracture or hip fracture.
In the last part of the talk Dr McCloskey described the result of the VERO trial showing the ability of Teriparatide to reduce new vertebral fracture compared to oral risedronate. Similar results were obtained from the trial comparing Romosozumab and Alendronate, indicating that anabolic treatments can rapidly and more effectively reduce the incidence of new vertebral fractures compared to oral bisphosphonates. These findings suggest that anabolic treatments should be considered as a first-line option for patients. Finally, he showed that treating patients early with the most effective therapy saves more fractures.
To watch the video please go to https://ectsoc.org/event/bmb-january2023/ and login with your username and password.