At this year’s ECTS in Marseille new guidelines on several clinical topics were presented in order to allow discussion and critique prior to publication.
The Bone Mineral Density Best Practice guidance emphasises on the integration of Vertebral Fracture Assessment (VFA) into routine DXA scanning as about two thirds of vertebral fractures are “silent” fractures and remain undiagnosed. A diagnosis of a vertebral fracture is key information to evaluate fracture risk and to guide treatment decisions.
The clinical working group also worked on updated GIOP guidelines for “non-experts”. The main message is that women and men over 50 years who are receiving glucocorticoids should immediately be started on osteoporosis treatment if:
- The T-score <-1.5
- Glucocorticoid dose >7.5 mg Prednisolone or equivalent
- Patients are >70 years of age or
- If the 10-year probability risk of major osteoporotic fracture, as calculated by glucocorticoid dose adjusted FRAX score, is above the country specific threshold.
Additional guidance was presented on the conservative treatment in the management of acute painful vertebral compression fractures. Teriparatide appears superior to bisphosphonates in managing pain and improving functional outcomes. However, the authors did acknowledge a relative lack of placebo-controlled trials. Surprisingly, calcitonin was also found to be effective, but approval restrictions may limit its clinical use. The systematic review also concluded that there is a paucity of high-quality studies that investigated analgesics (NSAIDs, opioids) and highlighted the urgent need for further research.
Furthermore, the results of the consensus initiative on sterile bone inflammation were presented with some key recommendations:
- The group agreed on the nomenclature of Chronic Nonbacterial Osteomyelitis (CNO)
- Diagnostic recommendations highlighted the importance of detailed imaging with either MRI, CT and/or nuclear medicine imaging
- Treatment recommendations suggested iv bisphosphonates or TNF inhibitors as second line treatment after a trial of NSAIDs.
The team also highlighted the need for further research into pathophysiology of CNO and on treatment strategies.
Beside all the new guidelines and research presented at the ECTS, the charity – and networking events, provided the delegates the opportunity to learn about local culture including pétanque, pastis and French rap.