Clinicians have 'a ways to go' in managing osteoporosis in women
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Women with osteoporosis are not being identified and treated at sufficient rates, according to a presenter at the 2020 Congress of Clinical Rheumatology-West.
Michael McClung, MD, founding director of the Oregon Osteoporosis Center, suggested that while novel therapeutic options do not cure osteoporosis, they can protect patients from fracture. But treatment must be ongoing.
“Osteoporosis is a chronic condition of impaired bone strength,” McClung said in his presentation. “We have come to appreciate that lifelong management of patients with osteoporosis is required.”
But lifelong management seems like a distant goal given that simply getting women on therapy has proven challenging, according to McClung. “Despite all of the advances, we are not accomplishing what we should or want to accomplish,” he said. “The majority of women with osteoporosis are not being identified, and the ones who are being identified are not being treated.”
One potential reason for this pertains to concerns about the long-term adverse events which may be associated with bisphosphonate therapy. “Fears cloud people’s thinking,” McClung said. “As a specialty, we have not communicated this benefit-risk ratio.”
The key benefit of bisphosphonates is that they can prevent bone loss and, according to some data sets, reduce fracture risk by as much as 50%. Alendronate (Binosto, Fosamax), ibandronate (Boniva, Genentech), risedronate (Actonel, Allergan) and zoledronic acid (Reclast, Novartis) are the key drugs in this class.
Denosumab (Prolia, Amgen) is an injectable therapy that can be administered every 6 months and will stave off bone loss with minimal adverse effects.
Similarly, teriparatide (Forteo, Eli Lilly & Co.) is a daily injectable anabolic drug that is approved for its capacity to stimulate new bone formation, decrease spinal fracture risk and increase bone density.
Ongoing data have shown that these drugs are effective. But McClung called on the research community to continue to investigate the pathogenesis of osteoporosis. He noted that it is “not understood how impaired bone formation happens.”
McClung also said rheumatologists need to be better advocates in this space, suggesting the need to “educate our general medicine colleagues and patients to appreciate that we have very effective management and diagnostic tools, along with a high benefit-to-risk profile.”
While many patients and practitioners say that diet and exercise can stave off bone loss and osteoporosis, McClung was adamant that “non-pharmacotherapy cannot, will not fix osteoporosis.”
“We have learned a whole lot but there is still a ways to go,” McClung said.
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McClung M. Osteoporosis. Presented at: Congress of Clinical Rheumatology-West annual symposium; October 8-11, 2020 (virtual meeting).
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