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Lots of new information, but nothing has changed!
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The 31st Annual Meeting of the American Society for Bone and Mineral Research is still in progress in Denver, and as anticipated, there is a plethora of new and exciting basic and clinical information presented — 1,672 abstracts were available for the oral and poster presentations but, regrettably in my opinion, only available on a thumb disk and not in a print version. The meeting is so busy that I skipped many of the oral sessions to spend more time reviewing the posters — there isn’t enough time to do both.
The most compelling clinical aspect in the bone field remains osteoporosis, and there are some important take home messages I want to get across — not for the first time.
1. The new drug pipeline for osteoporosis seems very healthy, particularly with therapies aimed at stimulating bone formation. New therapies for preventing bone resorption are not being ignored, but we have several very effective such drugs available and only one formation stimulation drug, teriparatide, that is FDA approved in the United States.
2. FRAX is being validated worldwide with most, but not all, countries documenting that the model can be applied successfully even though the epidemiology on which FRAX is based did not include information for most countries.
3. Every study that investigated the effectiveness of the available osteoporosis therapies in diverse “real world” clinical settings confirmed that the drugs do indeed reduce the incidence of new fractures, but ...
4. ONLY IF THE DRUGS ARE TAKEN AS PRESCRIBED! This is not a phenomenon unique to the osteoporosis field and remains one of the major obstacles to optimal care in clinical practice for diabetes, hypertension and dyslipidemia. Bisphosphonates are available orally daily, weekly or monthly, but switching from one treatment regimen to another does not seem to have improved patient adherence to therapy. Adherence is improved with the use of quarterly (ibandronate) or annual (zoledronic acid) infusions, but the clinical penetration of this approach needs improvement.
5. The side effects of bisphosphonates, particularly osteonecrosis of the jaw and femoral shaft fractures, receive a lot of public attention but the likelihood of these complications in your patients remains vanishingly small. It would be worthwhile to have available in your office the official statement on osteonecrosis of the jaw put together by an expert panel from the American Dental Association.
6. The most disappointing “new” information is only a few programs are able to report that the correct diagnosis and treatment of osteoporosis in patients with osteoporosis-related fractures can be improved. Many more investigators reported very low uptake of the diagnosis. I could not really gauge the true pearls reported by those groups who have had success, but it clearly takes a very dedicated group that includes every member of the health care team starting in the ER when the fracture is diagnosed. I saw many posters highlighting that failure to recognize and treat osteoporosis in those who have sustained a fracture is associated with a very high incidence of subsequent fractures and a several-fold increase in costs of care compared with those who were fortunate enough to be diagnosed and treated in a timelier manner.
If you are involved in a program successful in diagnosing and treating those with osteoporosis complicated by fragility fracture, please add a note to this blog so we can all learn. If you have tried and been unsuccessful let us know that too — we can learn as much if not more from our mistakes.
