Treatment of osteoporosis by an outpatient specialist
Authors:
J. Štěpán; K. Pavelka
Published in:
Prakt. Lék. 2024; 104(5-6): 236-241
Category:
Of different specialties
Overview
Štěpán J, Pavelka K. Treatment of osteoporosis by an outpatient specialist
General practitioners and gynecologists provide osteoporosis screening and treatment with oral aminobisphosphonates in women and men with primary osteoporosis or low-impact fractures, while referring patients with a very high risk of fractures in primary osteoporosis and patients with diagnosed or suspected secondary osteoporosis to an outpatient specialist. The article draws attention to the necessity of differential diagnosis of secondary causes of osteoporosis by general practitioners and referral of the patient to a specialist who is responsible for the necessary treatment. The priority measure in the specialist's outpatient clinic is not an expensive pharmacotherapy of secondary osteoporosis, but timely and effective treatment of the underlying disease, which prevents further decrease in bone mineral density, deterioration of bone quality and reduces the risk of osteoporotic fractures.
Keywords:
secondary osteoporosis – teriparatide – denosumab – differential diagnosis – zolendronic acid – romosozumab
Sources
- Kanis JA, Cooper C, Rizzoli R, et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2017; 28(7): 2023–2034.
- Ebeling PR, Nguyen HH, Aleksova J, et al. Secondary osteoporosis. Endocr Rev. 2022; 43(2): 240–313.
- Kanis JA, Norton N, Harvey NC, et al. SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos. 2021; 16(1): 82.
- Všeobecná zdravotní pojišťovna ČR. Metodika realizace populačního programu časného záchytu osteoporózy v ČR 2023 [online]. Dostupné z: https://media.vzpstatic.cz/media/Default/ dokumenty/mso/metodika-screening-osteoporoza-v-03-04-2024. pdf [cit. 2024-12-17].
- Vráblíková K, Palička V, Pikner R. Systém koordinované péče o osteoporotické pacienty v České republice. Clin Osteol. 2024; 29(1–2): 5–11.
- Zhuang Z, Huang C, Chen X, et al. Prevalence of osteoporosis in patients awaiting unicompartmental knee arthroplasty: a cross– sectional study. Front Endocrinol. 2023; 14: 1224890.
- Axelsson KF, Johansson H, Lundh D, et al. Association between recurrent fracture risk and implementation of Fracture Liaison Services in four Swedish hospitals: A cohort study. J Bone Miner Res. 2020; 35(7): 1216–1223.
- Dito G, Lugaresi M, Degradi C, et al. Efficacy of switching from teriparatide to zoledronic acid or denosumab on bone mineral density and biochemical markers of bone turnover in older patients with severe osteoporosis: a real-life study. Endocrine. 2023; 82(1): 181–189.
- Barrionuevo P, Kapoor E, Asi N, et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: A network meta-analysis. J Clin Endocrinol Metab. 2019; 104(5): 1623–1630.
- Willems D, Javaid MK, Pinedo-Villanueva R, et al. Importance of time point-specific indirect treatment comparisons of osteoporosis treatments: A systematic literature review and network meta-analyses. Clin Ther. 2022; 44(1): 81–97.
- Ayers C, Kansagara D, Lazur B, et al. Effectiveness and safety of treatments to prevent fractures in people with low bone mass or primary osteoporosis: A living systematic review and network meta-analysis for the American College of Physicians. Ann Intern Med. 2023; 176(2): 182–195.
- Lakatos P, Takacs I, Marton I, et al. A retrospective longitudinal database study of persistence and compliance with treatment of osteoporosis in Hungary. Calcif Tissue Int. 2016; 98(3): 215–225.
- Huybrechts KF, Ishak KJ, Caro JJ. Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 2006; 38(6): 922–928.
- Tripto-Shkolnik L, Fund N, Rouach V, et al. Fracture incidence after denosumab discontinuation: Real–world data from a large healthcare provider. Bone 2020; 130: 115150.
- Solling AS, Harslof T, Langdahl B. Treatment with zoledronate subsequent to denosumab in osteoporosis: A 2-year randomized study. J Bone Miner Res. 2021; 36(7): 1245–1254.
- Haugeberg G, Uhlig T, Falch JA, et al. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000; 43(3): 522–530.
- Kim Y, Kim G-T. Positive effects of biologics on osteoporosis in rheumatoid arthritis. J Rheum Dis. 2023; 30(1): 3–17.
- Smolen JS, Landewe RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease–modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023; 82(1): 3–18.
- Gulyás K, Horváth Á, Végh E, et al. Effects of 1-year anti-TNF-α therapies on bone mineral density and bone biomarkers in rheumatoid arthritis and ankylosing spondylitis. Clin Rheumatol. 2020; 39(1): 167–175.
- Frei R, Fournier N, Zeitz J, et al. Early initiation of anti-TNF is associated with favourable long-term outcome in Crohn’s disease: 10-year-follow-up data from the Swiss IBD Cohort Study. J Crohns Colitis. 2019; 13(10): 1292–1301.
- Baliram R, Sun L, Cao J, et al. Hyperthyroid–associated osteoporosis is exacerbated by the loss of TSH signaling. J Clin Invest. 2012; 122(10): 3737–3741.
- Khan A, Grey A, Shoback D. Medical management of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009; 94(2): 373–381.
- Štěpán J, Weiss V, Marek J, a kol. Spontánní úprava kortikosteroidní osteopenie po úspěšné chirurgické léčbě Cushingova syndromu. Průřezová studie. Čas. Lék. čes. 1997; 136(15): 464–467.
- Štěpán JJ, Hrušková H, Kverka M. Update on menopausal hormone therapy for fracture prevention. Curr Osteoporos Rep. 2019; 17(6): 465–473.
- Zawada A, Ratajczak AE, Rychter AM, et al. Treatment of diabetes and osteoporosis – a reciprocal risk? Biomedicines 2022; 10(9): 2191.
- Gifre L, Massó E, Fusaro M, et al. Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action. Clin Kidney J. 2024; 17(8): sfae191.
- Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009; 361(8): 756–765.
- Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014; 29(1): 1–23.
- Khan AA, Morrison A, Hanley DA, et al. Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus. J Bone Miner Res. 2015; 30(1): 3–23.
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General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2024 Issue 5-6
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