Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis
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- Steven R Cummings
- California Pacific Medical CenterResearch InstituteSan FranciscoCAUSA
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- Felicia Cosman
- Helen Hayes Hospital and Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkNYUSA
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- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis CenterAlbuquerqueNMUSA
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- John T Schousboe
- Park Nicollet Institute for Research and EducationDivision of RheumatologyMinneapolisMNUSA
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- Douglas C Bauer
- Departments of Medicine and Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCAUSA
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- Dennis M Black
- University of California, San FranciscoDepartment of Epidemiology and BiostatisticsSan FranciscoCAUSA
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- Thomas D Brown
- University of Iowa, Department of Orthopedics and RehabilitationIowa CityIAUSA
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- Angela M Cheung
- University of TorontoFaculty of MedicineOntarioCanada
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- Kathleen Cody
- Foundation for Osteoporosis Research and EducationOaklandCAUSA
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- Cyrus Cooper
- University of SouthamptonMRC Lifecourse Epidemiology UnitSouthhamptonUnited Kingdom
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- Adolfo Diez-Perez
- Hospital del Mar-IMIM-Universitat Autònoma de Barcelona and RETICEFInstituto Carlos III, Spain, Internal Medicine - Infectious DiseasesBarcelonaSpain
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- Richard Eastell
- University of SheffieldHuman MetabolismEnglandUnited Kingdom
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- Peyman Hadji
- Philipps-University of MarburgDepartment of EndocrinologyOsteoporosis, and Reproductive MedicineMarburgGermany
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- Takayuki Hosoi
- National Center for Geriatrics and GerontologyObu CityAichi PrefectureJapan
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- Suzanne Jan De Beur
- Johns Hopkins UniversityBaltimoreMDUSA
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- Risa Kagan
- University of California, San FranciscoSan FranciscoCAUSA
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- Douglas P Kiel
- Hebrew SeniorLifeInstitute for Aging ResearchBostonMAUSA
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- Ian R Reid
- University of AucklandDepartment of MedicineAucklandNew Zealand
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- Daniel H Solomon
- Brigham and Women's HospitalDivision of RheumatologyBostonMAUSA
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- Susan Randall
- National Osteoporosis FoundationArlingtonVAUSA
Abstract
<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 > –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>
Journal
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- Journal of Bone and Mineral Research
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Journal of Bone and Mineral Research 32 (1), 3-10, 2016-11-19
Oxford University Press (OUP)
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Details 詳細情報について
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- CRID
- 1360011144355483264
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- ISSN
- 15234681
- 08840431
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- Data Source
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- Crossref