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
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Article info
Publication history
Published online: May 29, 2019
Footnotes
Funding: None.
Conflicts of Interest: EML has received no direct income from potentially conflicting entities in the past year. His employer, New Mexico Clinical Research & Osteoporosis Center, has received research grants from Radius, Amgen, Mereo, Bindex; income for service on scientific advisory boards or consulting for Amgen, Radius, Alexion, Sandoz, Samsung Bioepis; service on speakers’ bureaus for Radius, Alexion; project development for University of New Mexico; and royalties from UpToDate for sections on DXA, fracture risk assessment, and prevention of osteoporosis. He is a board member of the National Osteoporosis Foundation, International Society for Clinical Densitometry, and Osteoporosis Foundation of New Mexico. DLK has received institutional grant/research support and speaking honoraria from Amgen, Pfizer, Astrazenica, and Eli Lilly. KSD has received speaking honoraria from Amgen. DAH has received institutional grant/research support and speaking honoraria from Amgen and Eli Lilly. STH has received speaker honoraria from Amgen, Eli Lilly, and Radius Health. MRM has received consulting fees from Amgen and speaking honoraria from Amgen and Radius Health. PDM has received scientific research grants from Amgen, Radius Health, Regeneron, Ultragenyx, National Bone Health Alliance, Immunodiagnostics, and Roche Diagnostics and serves on the Scientific Advisory Boards of Amgen, Radius Health, Ultragenyx, National Bone Health Alliance, and Sandoz.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
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