Bone Abstracts

Drug treatment for osteoporosis typically begins with an oral bisphosphonate, regardless of initial BMD or fracture risk and decisions to continue or change treatment are often based on evidence of ‘response’ to treatment based on changes in BMD, bone turnover markers, and occurrence of fractures. Treatment is often continued for fixed periods of time, perhaps stopped for a ‘drug holiday’.

This approach differs from preventive therapy for other conditions, such as hypertension, where treatment is based on achieving a goal. The goal could be a certain risk of fracture or level of BMD. Goal-directed treatment would individualize the initial choice of treatment based on the probability that alternatives would achieve the patient’s goal. In contrast to changing treatments based on years of use or failure to respond, the patient’s BMD and risk would be reassessed periodically and decisions to stop or change treatment would be based on achieving or maximizing the chance of reaching an acceptable level of fracture risk or BMD.

A task force of the ASBMR and US National Osteoporosis Foundation, including clinicians and scientists from many specialties and countries, has been developing recommendations about goal-directed treatment for osteoporosis. I will provide an update on the issues and recommendations being considered by the task force.