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

  • Steven R Cummings
    California Pacific Medical CenterResearch InstituteSan FranciscoCAUSA
  • Felicia Cosman
    Helen Hayes Hospital and Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkNYUSA
  • E Michael Lewiecki
    New Mexico Clinical Research & Osteoporosis CenterAlbuquerqueNMUSA
  • John T Schousboe
    Park Nicollet Institute for Research and EducationDivision of RheumatologyMinneapolisMNUSA
  • Douglas C Bauer
    Departments of Medicine and Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCAUSA
  • Dennis M Black
    University of California, San FranciscoDepartment of Epidemiology and BiostatisticsSan FranciscoCAUSA
  • Thomas D Brown
    University of Iowa, Department of Orthopedics and RehabilitationIowa CityIAUSA
  • Angela M Cheung
    University of TorontoFaculty of MedicineOntarioCanada
  • Kathleen Cody
    Foundation for Osteoporosis Research and EducationOaklandCAUSA
  • Cyrus Cooper
    University of SouthamptonMRC Lifecourse Epidemiology UnitSouthhamptonUnited Kingdom
  • Adolfo Diez-Perez
    Hospital del Mar-IMIM-Universitat Autònoma de Barcelona and RETICEFInstituto Carlos III, Spain, Internal Medicine - Infectious DiseasesBarcelonaSpain
  • Richard Eastell
    University of SheffieldHuman MetabolismEnglandUnited Kingdom
  • Peyman Hadji
    Philipps-University of MarburgDepartment of EndocrinologyOsteoporosis, and Reproductive MedicineMarburgGermany
  • Takayuki Hosoi
    National Center for Geriatrics and GerontologyObu CityAichi PrefectureJapan
  • Suzanne Jan De Beur
    Johns Hopkins UniversityBaltimoreMDUSA
  • Risa Kagan
    University of California, San FranciscoSan FranciscoCAUSA
  • Douglas P Kiel
    Hebrew SeniorLifeInstitute for Aging ResearchBostonMAUSA
  • Ian R Reid
    University of AucklandDepartment of MedicineAucklandNew Zealand
  • Daniel H Solomon
    Brigham and Women's HospitalDivision of RheumatologyBostonMAUSA
  • Susan Randall
    National Osteoporosis FoundationArlingtonVAUSA

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<jats:title>ABSTRACT</jats:title> <jats:p>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 &gt; –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. © 2016 American Society for Bone and Mineral Research.</jats:p> <jats:p>Abstract</jats:p> <jats:p>The fundamental principle of treat-to-goal for osteoporosis is that treatment should be selected according to having a high likelihood of achieving an acceptable level of fracture risk. This is different than but complementary to the current paradigm of monitoring for response to therapy, usually with bone density testing by DXA or bone turnover markers. A patient may respond to therapy yet continue to have an unacceptably high fracture risk. Response to treatment is essential but not necessarily sufficient in achieving an acceptable level of fracture risk.</jats:p>

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