Management of patients at very high risk of osteoporotic fractures through sequential treatments.

Autor:	Curtis, Elizabeth M., Reginster, Jean-Yves, Al-Daghri, Nasser, Biver, Emmanuel, Brandi, Maria Luisa, Cavalier, Etienne, Hadji, Peyman, Halbout, Philippe, Harvey, Nicholas C., Hiligsmann, Mickaël, Javaid, M. Kassim, Kanis, John A., Kaufman, Jean-Marc, Lamy, Olivier, Matijevic, Radmila, Perez, Adolfo Diez, Radermecker, Régis Pierre, Rosa, Mário Miguel, Thomas, Thierry, Thomasius, Friederike
Předmět:	BONE fracture prevention OSTEOPOROSIS prevention OSTEOPOROSIS treatment CONSENSUS (Social sciences) TERIPARATIDE MACHINE learning RISK assessment OSTEOPOROSIS DRUGS COST effectiveness BONE density DECISION making in clinical medicine ANABOLIC steroids PATIENT compliance BONE fractures DISEASE risk factors DISEASE complications
Zdroj:	Aging Clinical & Experimental Research; Apr2022, Vol. 34 Issue 4, p695-714, 20p
Abstrakt:	Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an "anabolic first" approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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