European osteoporosis pharmacological guidelines confirm current recommended treatment whilst answering important management questions
Abstract
One in 3 women and 1 in 5 men over the age of 50 will sustain an osteoporotic fracture.1 These fractures are often associated with significant morbidity and increased mortality.1,2 The economic burden of osteoporotic fractures is enormous.1 Fracture risk is much higher in the elderly than in younger people.2 With an ever increasing life expectancy, the prevalence of fragility fractures can be expected to rise exponentially.1 It is estimated that by 2050 there will be in excess of 5 million hip fractures globally.3 However, despite this high prevalence of osteoporosis, less than 20% of osteoporotic patients are assessed for fracture risk, screened for osteoporosis or initiated on appropriate secondary prevention including calcium or vitamin D supplementation.1,2 A decline has been shown in both treatment initiation and adherence rates, especially in bisphosphonate treatment.2,4 This has manifested in a higher incidence of hip fracture than what was projected in the United States, following a more than 10-year period of decline in hip fracture incidence.2 Factors playing a role in sub-optimal treatment include a lack of disease awareness as well as uncertainty amongst treating physicians and patient fears. Physicians may be unsure regarding appropriate screening, identifying patients at high fracture risk, especially imminent fracture risk, appropriate treatment initiation and duration of treatment, as well as when to institute “drug holidays”. A further barrier to treatment initiation and adherence is patient concerns regarding route of administration, tolerability and fear of possible, although rare, side effects, such as osteonecrosis of the jaw (ONJ) and atypical femur fracture (AFF).2,5
