Clin Osteol 2017; 22(2): 51-55

Ineffective and failed treatment of osteoporosisGuidelines

J. Rosa, V. Palička, P. Horák, K. Pavelka, R. Pikner, F. Šenk, V. Vyskočil, V. Zikán

The goal of osteoporosis treatment, that is, reducing the risk of fractures, cannot be adequately monitored in clinical practice. At an individual level, surrogate markers of treatment effectiveness must be used, that are related to the risk of frac­ tures - bone mineral density (BMD) and bone turnover markers (BTMs). All antiosteoporotic drugs reduce the risk of fractures but do not eliminate it completely. In most antiresorptive agents, increased BMD is associated with a reduced risk of fracture. The strength of this association, however, depends on the antiresorptive potency of a particular agent, ty­ pe of densitometry region of interest and type of assessed fracture. A general problem of BMD as an instrument for mo­ nitoring the effectiveness of antiresorptive therapy for osteoporosis is the fact that with serial measurements, the least sig­ nificant change is usually the same or greater than the expected change in BMD after one-year treatment. A decrease in BTMs during antiresorptive therapy usually means a reduced risk of fractures but, once again, the relationship may not be linear. Another general problem is a lack of standardization of the methods used. An ideal parameter of the effecti­ veness of treatment with the osteoanabolic teriparatide is an increase in P1NP at 3-6 months of treatment; in antire­ sorptive methods, bone resorption markers are usually preferred. Many real practice studies used some working criteria for effective/ineffective treatment but only the International Osteoporosis Foundation addressed the issue systematically. With respect to the above facts, the Czech Society for Metabolic Skeletal Disease task group recommends to consider #FOOTER#:Osteologický bulletin 2017 č. 2 roč. 22 51 #HEADER#:DOPORUČENÝ POSTUP changes to the treatment of osteoporosis in cases of (a) a new osteoporotic fracture (in particular multiple fractures) or (b) inadequate BMD response or (c) inadequate BTM response to the existing therapy. Leaving more space to clinical as­ sessment of individual patients is supported by experience from many years of anti Great stress is placed on proper measurements of BMD and determination of BTMs.

Keywords: osteoporosis, treatmentfailure, bisphosphonates, denosumab, teriparatide Osteologický bulletin 2017, 22(2)51-55

Published: December 11, 2017  Show citation

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Rosa J, Palička V, Horák P, Pavelka K, Pikner R, Šenk F, et al.. Ineffective and failed treatment of osteoporosis. Osteologický bulletin. 2017;22(2):51-55.
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