Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Steven R. Cummings, Felicia Cosman, E. Michael Lewiecki, John T. Schousboe, Douglas C. Bauer, Dennis M. Black, Thomas D. Brown, Angela M. Cheung, Kathleen Cody, Cyrus Cooper, Adolfo Diez-Perez, Richard Eastell, Peyman Hadji, Takayuki Hosoi, Suzanne M Jan De Beur, Risa Kagan, Douglas P. Kiel, Ian R. Reid, Daniel H. Solomon, Susan Randall

Research output: Contribution to journalArticle

Abstract

The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goal-directed treatment, a treatment goal would first be established and choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > –2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment. Progress toward reaching the patient's goal would be periodically and systematically assessed by estimating the patient's compliance with treatment, reviewing fracture history, repeating vertebral imaging when indicated, and repeating measurement of bone mineral density (BMD). Using these data, a decision would be made to stop, continue, or change therapy. Some of these approaches can now be applied to clinical practice. However, the application of goal-directed treatment cannot be fully achieved until medications are available that provide greater increases in BMD and greater reduction in fracture risk than those that are currently approved; only then can patients with very high fracture risk and very low BMD achieve such goals. Furthermore, assessing future fracture risk in patients on treatment requires a new assessment tool that accurately captures the change in fracture risk associated with treatment and should also be sensitive to the importance of recent fractures as predictors of imminent fracture risk. Lastly, evidence is needed to confirm that selecting and switching treatments to achieve goals reduces fracture risk more effectively than current standard care.

Original languageEnglish (US)
Pages (from-to)3-10
Number of pages8
JournalJournal of Bone and Mineral Research
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2017

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Osteoporosis
Therapeutics
Bone Density
Fracture Fixation
Patient Compliance

Keywords

  • GOAL
  • OSTEOPOROSIS
  • TARGET
  • TREAT-TO-GOAL
  • TREAT-TO-TARGET
  • TREATMENT

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

Goal-Directed Treatment for Osteoporosis : A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis. / Cummings, Steven R.; Cosman, Felicia; Lewiecki, E. Michael; Schousboe, John T.; Bauer, Douglas C.; Black, Dennis M.; Brown, Thomas D.; Cheung, Angela M.; Cody, Kathleen; Cooper, Cyrus; Diez-Perez, Adolfo; Eastell, Richard; Hadji, Peyman; Hosoi, Takayuki; Jan De Beur, Suzanne M; Kagan, Risa; Kiel, Douglas P.; Reid, Ian R.; Solomon, Daniel H.; Randall, Susan.

In: Journal of Bone and Mineral Research, Vol. 32, No. 1, 01.01.2017, p. 3-10.

Research output: Contribution to journalArticle

Cummings, SR, Cosman, F, Lewiecki, EM, Schousboe, JT, Bauer, DC, Black, DM, Brown, TD, Cheung, AM, Cody, K, Cooper, C, Diez-Perez, A, Eastell, R, Hadji, P, Hosoi, T, Jan De Beur, SM, Kagan, R, Kiel, DP, Reid, IR, Solomon, DH & Randall, S 2017, 'Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis', Journal of Bone and Mineral Research, vol. 32, no. 1, pp. 3-10. https://doi.org/10.1002/jbmr.3039
Cummings, Steven R. ; Cosman, Felicia ; Lewiecki, E. Michael ; Schousboe, John T. ; Bauer, Douglas C. ; Black, Dennis M. ; Brown, Thomas D. ; Cheung, Angela M. ; Cody, Kathleen ; Cooper, Cyrus ; Diez-Perez, Adolfo ; Eastell, Richard ; Hadji, Peyman ; Hosoi, Takayuki ; Jan De Beur, Suzanne M ; Kagan, Risa ; Kiel, Douglas P. ; Reid, Ian R. ; Solomon, Daniel H. ; Randall, Susan. / Goal-Directed Treatment for Osteoporosis : A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis. In: Journal of Bone and Mineral Research. 2017 ; Vol. 32, No. 1. pp. 3-10.
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