EditorialMaking sure the first osteoporotic fracture is also the last
Section snippets
Where are we now?
The situation remains lackluster, and a growing number of editorials are focusing on how to handle the osteoporosis crisis [1], [2]. According to the latest report by the International Osteoporosis Foundation (IOF), 380 000 new fractures occurred in France in 2017, resulting in a cost of about 5.4 billion Euros for the year, and the projection for 2030 indicates a worrisome increase in the incidence of osteoporotic fractures, of 26%, for an annual cost of 6.8 billion Euros (https////www.iofbonehealth.org/broken-bones-broken-lives
Barriers to optimal management
Recommendations exist for the diagnosis and treatment of osteoporosis, and osteoporosis medications are reimbursed in France by the statutory healthcare insurance. Why then do patients remain untreated? Osteoporosis is often not viewed by the public, patients, and physicians as a true disease–a serious disease that can cause life-threatening fractures and that requires specific treatment, with the attendant risks [1], [7] These facts are strikingly illustrated by a qualitative study conducted
Avenues toward better management
Fracture liaison services (FLSs) involving multidisciplinary models for secondary fracture prevention have gained universal recognition (https//www.iofbonehealth.org/broken-bones-broken-lives). A recent meta-analysis of 74 controlled trials showed a 20% increase in patients started on treatment, a 22% improvement in treatment adherence and, most importantly, a 5-point decrease in the absolute risk of recurrent fracture and a 3-point decrease in the risk of death [12]. An even more recent study
Treatment efficacy and safety–Advances in the management of very severe osteoporosis
Effective osteoporosis medications are available, including the bone resorption inhibitors bisphosphonates and denosumab. After 3 years of bisphosphonate therapy, significant decreases were obtained in the risk of vertebral fractures (40%–70%), nonvertebral fractures (25%–40%), and hip fractures (40%–53 %); corresponding decreases with denosumab were 68%, 20%, and 40%, respectively [3]. The risk of atypical femoral fracture during bisphosphonate therapy is low but increases when treatment
Conclusion
Although much remains to be done to ensure that the first osteoporotic fracture is also the last, avenues toward improvement have been identified. One is the development of FLSs capable of capturing the fracture within the window of opportunity. Greater dissemination of data on the efficacy, and also the safety, of osteoporosis medications is another. For patients with the most severe forms of osteoporosis, an anabolic agent followed by a bone resorption inhibitor and/or long-term treatment are
Disclosure of interest
Honoraria for occasional interventions or consultancy work for Amgen, Lilly, and UCB.
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Cited by (3)
Effectiveness of fracture liaison services in osteoporosis
2024, Revue du Rhumatisme (Edition Francaise)Effectiveness of fracture liaison services in osteoporosis
2023, Joint Bone SpineManagement of bone fragility in patients with rheumatoid arthritis in France: An analysis of a national health insurance claims database
2022, Joint Bone SpineCitation Excerpt :Overall, the prevalence of osteoporosis is higher than in the general population [6,8,9,12]. The management of bone fragility in patients with RA, particularly those exposed to glucocorticoids, has been described as suboptimal [13–15]. Simultaneously, the occurrence of vertebral fractures suffered by RA patients has kept increasing despite the availability of efficient RA treatments [9,16,17].