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Arch Osteoporos. 2016 Dec;11(1):37. Epub 2016 Oct 31.

Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture.

Author information

1
Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland.
2
Bone and Cartilage Metabolism Unit, University of Liège, Liège, Belgium.
3
Section of Endocrinology, Unit of Bone and Mineral Metabolism, Department of Surgery and Translational Medicine, Florence, Italy.
4
Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia.
5
University of Sheffield Medical School, Sheffield, UK.
6
Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
7
Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.
8
Orthopaedic and Trauma Department, Saint Antoine Hospital, UPMC-Sorbonne Universities, Paris, France.
9
Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Dusseldorf, Germany.
10
Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland. rene.rizzoli@unige.ch.

Abstract

This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture.

PURPOSE:

Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered.

METHODS:

A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions.

RESULTS:

Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation.

CONCLUSION:

Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.

KEYWORDS:

BMD; Bone strength; Fracture; Osteoporosis; Surgical treatment; Treatment

PMID:
27800591
PMCID:
PMC5306171
DOI:
10.1007/s11657-016-0292-1
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Compliance with ethical standardsConflicts of interestSF received consulting fees from Agnovos, Amgen, Eli Lilly, MSD, Radius Health and UCB.JPD was granted travel supports from Amgen.JAK reports grants from Amgen, Lilly and Radius Health; non-financial support from Medimaps; non-financial support from Asahi; and institutional support from AgNovos.JYR received advisory board or speaker fees from Amgen, Analis, Asahi-Kasei, Danone, Ebewee, Eli Lilly, Endocyte, GlaxoSmithKline, IBSA-Genevrier, MSD, Merckle, Negma, Novartis, Novo-Nordisk, NPS, Nycomed-Takeda, PharmEvo, Radius Health, Roche, Rottapharm, Servier, Teijin, Teva, Theramex, UCB, Will Pharma, Wyeth and Zodiac.MLB has nothing to disclose in relation with the present paper.JMK received consulting or speaker fees from Amgen, Eli Lilly and Servier.JMF received consulting or speaker fees from Amgen, Eli Lilly and Servier.AK received consulting and speaker fees from Agnovos, Amgen, Eli Lilly, Novartis, Novo-Nordisk, Roche, Servier, Teva, Theramex, BioMEt and Dfine.RR received fees for advisory board or lectures from Danone, Labatec, Nestlé, ObsEva and Radius Health.

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