Addressing the Crisis in the Treatment of Osteoporosis: A Path Forward

Sundeep Khosla, Jane A. Cauley, Juliet Compston, Douglas P. Kiel, Clifford Rosen, Kenneth G. Saag, Elizabeth Shane

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Considerable data and media attention have highlighted a potential “crisis” in the treatment of osteoporosis. Specifically, despite the availability of several effective drugs to prevent fractures, many patients who need pharmacological therapy are either not being prescribed these medications or if prescribed a medication, are simply not taking it. Although there are many reasons for this “gap” in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of side effects, especially atypical femur fractures (AFFs) related to bisphosphonate (and perhaps other antiresorptive) drug therapy. In this perspective, we review the current state of undertreatment of patients at increased fracture risk and suggest possible short-, intermediate-, and long-term approaches to address patient concerns, specifically those related to AFF risk. We suggest improved patient and physician education on prodromal symptoms, extended femur scans using dual-energy X-ray absorptiometry (DXA) to monitor patients on antiresorptive treatment, better identification of high-risk patients perhaps using geometrical parameters from DXA and other risk factors, and more research on pharmacogenomics to identify risk markers. Although not the only impediment to appropriate treatment of osteoporosis, concern over AFFs remains a major issue and one that needs to be resolved for effective dissemination of existing treatments to reduce fracture risk.

Original languageEnglish (US)
Pages (from-to)424-430
Number of pages7
JournalJournal of Bone and Mineral Research
Volume32
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Osteoporosis
Femur
Photon Absorptiometry
Therapeutics
Bone Density Conservation Agents
Prodromal Symptoms
Physicians
Pharmacogenetics
Diphosphonates
Patient Education
Pharmacology
Drug Therapy
Research
Pharmaceutical Preparations

Keywords

  • DXA
  • FRACTURE PREVENTION
  • OSTEOPOROSIS

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

Khosla, S., Cauley, J. A., Compston, J., Kiel, D. P., Rosen, C., Saag, K. G., & Shane, E. (2017). Addressing the Crisis in the Treatment of Osteoporosis: A Path Forward. Journal of Bone and Mineral Research, 32(3), 424-430. https://doi.org/10.1002/jbmr.3074

Addressing the Crisis in the Treatment of Osteoporosis : A Path Forward. / Khosla, Sundeep; Cauley, Jane A.; Compston, Juliet; Kiel, Douglas P.; Rosen, Clifford; Saag, Kenneth G.; Shane, Elizabeth.

In: Journal of Bone and Mineral Research, Vol. 32, No. 3, 01.03.2017, p. 424-430.

Research output: Contribution to journalArticle

Khosla, S, Cauley, JA, Compston, J, Kiel, DP, Rosen, C, Saag, KG & Shane, E 2017, 'Addressing the Crisis in the Treatment of Osteoporosis: A Path Forward', Journal of Bone and Mineral Research, vol. 32, no. 3, pp. 424-430. https://doi.org/10.1002/jbmr.3074
Khosla, Sundeep ; Cauley, Jane A. ; Compston, Juliet ; Kiel, Douglas P. ; Rosen, Clifford ; Saag, Kenneth G. ; Shane, Elizabeth. / Addressing the Crisis in the Treatment of Osteoporosis : A Path Forward. In: Journal of Bone and Mineral Research. 2017 ; Vol. 32, No. 3. pp. 424-430.
@article{32b88a2293f746bd9411bcfbc66b0e0a,
title = "Addressing the Crisis in the Treatment of Osteoporosis: A Path Forward",
abstract = "Considerable data and media attention have highlighted a potential “crisis” in the treatment of osteoporosis. Specifically, despite the availability of several effective drugs to prevent fractures, many patients who need pharmacological therapy are either not being prescribed these medications or if prescribed a medication, are simply not taking it. Although there are many reasons for this “gap” in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of side effects, especially atypical femur fractures (AFFs) related to bisphosphonate (and perhaps other antiresorptive) drug therapy. In this perspective, we review the current state of undertreatment of patients at increased fracture risk and suggest possible short-, intermediate-, and long-term approaches to address patient concerns, specifically those related to AFF risk. We suggest improved patient and physician education on prodromal symptoms, extended femur scans using dual-energy X-ray absorptiometry (DXA) to monitor patients on antiresorptive treatment, better identification of high-risk patients perhaps using geometrical parameters from DXA and other risk factors, and more research on pharmacogenomics to identify risk markers. Although not the only impediment to appropriate treatment of osteoporosis, concern over AFFs remains a major issue and one that needs to be resolved for effective dissemination of existing treatments to reduce fracture risk.",
keywords = "DXA, FRACTURE PREVENTION, OSTEOPOROSIS",
author = "Sundeep Khosla and Cauley, {Jane A.} and Juliet Compston and Kiel, {Douglas P.} and Clifford Rosen and Saag, {Kenneth G.} and Elizabeth Shane",
year = "2017",
month = "3",
day = "1",
doi = "10.1002/jbmr.3074",
language = "English (US)",
volume = "32",
pages = "424--430",
journal = "Journal of Bone and Mineral Research",
issn = "0884-0431",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Addressing the Crisis in the Treatment of Osteoporosis

T2 - A Path Forward

AU - Khosla, Sundeep

AU - Cauley, Jane A.

AU - Compston, Juliet

AU - Kiel, Douglas P.

AU - Rosen, Clifford

AU - Saag, Kenneth G.

AU - Shane, Elizabeth

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Considerable data and media attention have highlighted a potential “crisis” in the treatment of osteoporosis. Specifically, despite the availability of several effective drugs to prevent fractures, many patients who need pharmacological therapy are either not being prescribed these medications or if prescribed a medication, are simply not taking it. Although there are many reasons for this “gap” in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of side effects, especially atypical femur fractures (AFFs) related to bisphosphonate (and perhaps other antiresorptive) drug therapy. In this perspective, we review the current state of undertreatment of patients at increased fracture risk and suggest possible short-, intermediate-, and long-term approaches to address patient concerns, specifically those related to AFF risk. We suggest improved patient and physician education on prodromal symptoms, extended femur scans using dual-energy X-ray absorptiometry (DXA) to monitor patients on antiresorptive treatment, better identification of high-risk patients perhaps using geometrical parameters from DXA and other risk factors, and more research on pharmacogenomics to identify risk markers. Although not the only impediment to appropriate treatment of osteoporosis, concern over AFFs remains a major issue and one that needs to be resolved for effective dissemination of existing treatments to reduce fracture risk.

AB - Considerable data and media attention have highlighted a potential “crisis” in the treatment of osteoporosis. Specifically, despite the availability of several effective drugs to prevent fractures, many patients who need pharmacological therapy are either not being prescribed these medications or if prescribed a medication, are simply not taking it. Although there are many reasons for this “gap” in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of side effects, especially atypical femur fractures (AFFs) related to bisphosphonate (and perhaps other antiresorptive) drug therapy. In this perspective, we review the current state of undertreatment of patients at increased fracture risk and suggest possible short-, intermediate-, and long-term approaches to address patient concerns, specifically those related to AFF risk. We suggest improved patient and physician education on prodromal symptoms, extended femur scans using dual-energy X-ray absorptiometry (DXA) to monitor patients on antiresorptive treatment, better identification of high-risk patients perhaps using geometrical parameters from DXA and other risk factors, and more research on pharmacogenomics to identify risk markers. Although not the only impediment to appropriate treatment of osteoporosis, concern over AFFs remains a major issue and one that needs to be resolved for effective dissemination of existing treatments to reduce fracture risk.

KW - DXA

KW - FRACTURE PREVENTION

KW - OSTEOPOROSIS

UR - http://www.scopus.com/inward/record.url?scp=85010644784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010644784&partnerID=8YFLogxK

U2 - 10.1002/jbmr.3074

DO - 10.1002/jbmr.3074

M3 - Article

C2 - 28099754

AN - SCOPUS:85010644784

VL - 32

SP - 424

EP - 430

JO - Journal of Bone and Mineral Research

JF - Journal of Bone and Mineral Research

SN - 0884-0431

IS - 3

ER -