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Am J Med. 2019 May 29. pii: S0002-9343(19)30441-3. doi: 10.1016/j.amjmed.2019.04.044. [Epub ahead of print]

Western Osteoporosis Alliance Clinical Practice Series: Treat-to-Target for Osteoporosis.

Author information

1
New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM. Electronic address: mlewiecki@gmail.com.
2
Department of Medicine (Endocrinology), University of British Columbia, Vancouver, Canada.
3
A Priori Medical Sciences, Inc., Victoria, British Columbia, Canada.
4
Departments of Medicine, Community Health Sciences, and Oncology, Cumming School of Medicine and McCaig Institute for Bone and Joint Health Cumming School of Medicine, The University of Calgary, Calgary, Alberta, Canada.
5
University of California, San Francisco, CA.
6
Oregon Osteoporosis Center and Oregon Health & Science University, Portland, OR; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
7
Colorado Center for Bone Research, Lakewood, CO.

Abstract

Patients often start treatment to reduce fracture risk because of a bone mineral density T-score consistent with osteoporosis (≤ -2.5). Others with a T-score above -2.5 may be treated when there is a history of fragility fracture or when a fracture risk algorithm categorizes them as having a high risk for fracture. It is common to initiate therapy with a generic oral bisphosphonate, unless contraindicated, and continue therapy if the patient is responding as assessed by stability or an increase in bone mineral density. However, some patients may respond well to an oral bisphosphonate, yet remain with an unacceptably high risk for fracture. Recognition of this occurrence has led to the development of an alternative strategy: treat-to-target. This involves identifying a biological marker (treatment target) that represents an acceptable fracture risk and then initiating treatment with an agent likely to reach this target. If the patient is on a path to reaching the target with initial therapy, treatment is continued. If it appears the target will not be reached with initial therapy, treatment is changed to an agent more likely to achieve the goal.

KEYWORDS:

Bone mineral density; Bone turnover markers; Goal; Osteoporosis; Treatment target

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