A broader strategy for osteoporosis interventions

• Published in: Nature reviews. Endocrinology 2020-06, Vol.16 (6), p.333-339
• Main Author: Reid, Ian R.
• Format: Article
• Language: English
• Subjects: 692/163/2743/316/801; 692/700/459/1748; Aged; Aged, 80 and over; Bisphosphonates; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - therapeutic use; Bone mineral density; Clinical trials; Diphosphonates - therapeutic use; Endocrinology; Female; Fractures; Health risk assessment; Humans; Medicine; Medicine & Public Health; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal - epidemiology; Osteoporosis, Postmenopausal - prevention & control; Osteoporosis, Postmenopausal - therapy; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - prevention & control; Perspective; Post-menopause; Postmenopausal women; Postmenopause; Practice Patterns, Physicians' - organization & administration; Practice Patterns, Physicians' - statistics & numerical data; Practice Patterns, Physicians' - trends
• ISSN: 1759-5029; 1759-5037
• DOI: 10.1038/s41574-020-0339-7

Approximately 50% of women experience at least one bone fracture postmenopause. Current screening approaches target anti-fracture interventions to women aged >60 years who satisfy clinical risk and bone mineral density criteria for osteoporosis. Intervention is only recommended in 7–25% of those women screened currently, well short of the 50% who experience fractures. Large screening trials have not shown clinically significant decreases in the total fracture numbers. By contrast, six large clinical trials of anti-resorptive therapies (for example, bisphosphonates) have demonstrated substantial decreases in the number of fractures in women not identified as being at high risk of fracture. This finding suggests that broader use of generic bisphosphonates in women selected by age or fracture risk would result in a reduction in total fracture numbers, a strategy likely to be cost-effective. The utility of the current bone density definition of osteoporosis, which neither corresponds with who suffers fractures nor defines who should be treated, requires reappraisal. Osteoporosis interventions are currently recommended in a small proportion of postmenopausal women, of whom ~50% will experience bone fracture. This Perspectives proposes that broader use of generic bisphosphonates would result in reductions in total fracture numbers and suggests that the current bone density definition of osteoporosis requires reappraisal.