Advertisement

Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

  • J. A. KanisEmail author
  • N. C. Harvey
  • E. McCloskey
  • O. Bruyère
  • N. Veronese
  • M. Lorentzon
  • C. Cooper
  • R. Rizzoli
  • G. Adib
  • N. Al-Daghri
  • C. Campusano
  • M. Chandran
  • B. Dawson-Hughes
  • K. Javaid
  • F. Jiwa
  • H. Johansson
  • J. K. Lee
  • E. Liu
  • D. Messina
  • O. Mkinsi
  • D. Pinto
  • D. Prieto-Alhambra
  • K. Saag
  • W. Xia
  • L. Zakraoui
  • J. -Y. Reginster
Position Paper

Abstract

Summary

Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures.

Introduction

The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach.

Methods

Clinical perspective and updated literature search.

Results

The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis.

Conclusions

A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions.

Keywords

Anabolic agents Fracture risk assessment FRAX Inhibitors of bone resorption Treatment of osteoporosis 

Notes

Acknowledgements

We are grateful to the Scientific Advisory Board of ESCEO and the Committee of Scientific Advisors and the Committee of National Societies of the IOF for their review and endorsement of the recommendations in this guidance.

Compliance with ethical standards

Conflicts of interest

NM Al-Daghri G Adib, C Campusano, M Chandran, F Jiwa, H Johansson, JK Lee, E Liu, D Pinto, N Veronese, W Xia, L Zakraoui have no conflicts of interest to declare.

O Bruyère received research grants from Biophytis, IBSA, MEDA, Servier and SMB and consulting or lecture fees from Amgen, Biophytis, IBSA, MEDA, Servier, SMB, TRB Chemedica and UCB.

C Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda and UCB.

B. Dawson-Hughes has received grant support from Pfizer and DSM and consulting fees from TTY Biopharma Co, Ltd, Intrinsic Therapeutics and Agnovos.

NC Harvey has received consultancy/lecture fees/honoraria/grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Radius Health, Servier, Shire, UCB, Consilient Healthcare and Internis Pharma.

MK Javaid has received honoraria, unrestricted research grants, travel and/or subsistence expenses from Amgen, Lilly UK, Internis, Consilient Health, Zebra Medical Vision, Kyowa Kirin Hakin and UCB.

JA Kanis reports grants from Amgen, Eli Lilly and Radius Health and consulting fees from Theramex. JAK is the architect of FRAX® but has no financial interest.

M Lorentzon has received lecture fees from Amgen, Lilly, Meda, Renapharma and UCB Pharma and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma and Consilient Health, all outside the presented work.

EV McCloskey has received consultancy/lecture fees/grant funding/honoraria from ActiveSignal, AgNovos, Amgen, AstraZeneca, Consilient Healthcare, Fresenius Kabi, Gilead, GSK, Hologic, Internis, Lilly, Medtronic, Merck, Novartis, Pfizer, Radius Health, Redx Oncology, Roche, SanofiAventis, Servier, Synexus, Tethys, UCB, Viiv, Warner Chilcott, I3 Innovus and Unilever.

OD Messina has received honoraria from Amgen, Lilly, Novartis and Pfizer

O Minski received honorary fees for lectures, from Abbvie, Roche, Pfizer, Pierre Fabre, Janssen, Novartis and MSD.

D Prieto-Alhambra’s research group has received research grants from Amgen, Servier and UCB; speaker fees from Amgen and UCB; educational grants from Johnson & Johnson and consultancy fees from Amgen and UCB.

J-Y Reginster has received advisory board or consulting fees from IBSA-Genévrier, Pierre Fabre, Radius Health, TEVA and Mylan; lecture fees from Agnovos, IBSA-Genévrier, Mylan, CNIEL, Dairy Research Council (DRC) and Theramex and institutional grant support from IBSA-Genévrier, Mylan, CNIEL and Radius Health.

R Rizzoli has received consulting fees or advisory board fees from Radius Health, Labatec, Danone, Nestlé, CNIEL and Sandoz.

K Saag reports grant support from Amgen and Radius and consulting fees from Amgen, Radius and Roche.

References

  1. 1.
    Kanis JA, Cooper C, Rizzoli R, Reginster J-Y, Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30:3–44CrossRefGoogle Scholar
  2. 2.
    Kanis JA, Cooper C, Rizzoli R, Reginster J-Y (2019) Executive summary of European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Aging Clin Exp Res 31:15–17PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Kanis JA, Cooper C, Rizzoli R, Reginster J-Y (2019) Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int 104:235–238PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Johnell O, Oden A, Caulin F, Kanis JA (2001) Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporos Int 12:207–214PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Pettersen C, De Laet C, Jonsson B (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Nymark T, Lauritsen JM, Ovesen O, Röck ND, Jeune B (2006) Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study. Osteoporos Int 17:1353–1357PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Giangregorio LM, Leslie WD (2010) Manitoba bone density program. Time since prior fracture is a risk modifier for 10-year osteoporotic fractures. J Bone Miner Res 25:1400–1405PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    van Geel TACM, van Helden S, Geusens PP, Winkens B, Dinant G-J (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:99–102PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, Sigurdsson G, Kanis JA (2017) Imminent risk of fracture after fracture. Osteoporos Int 28:775–780PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P (2018) Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 391(10117):230–240PubMedCrossRefGoogle Scholar
  11. 11.
    Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, Maddox J, Fan M, Meisner PD, Grauer A (2017) Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med 377:1417–1427PubMedCrossRefGoogle Scholar
  12. 12.
    Barrionuevo P, Kapoor E, Asi N, Alahdab F, Mohammed K, Benkhadra K, Almasri J, Farah W, Sarigianni M, Muthusamy K, Al Nofal A, Haydour Q, Wang Z, Murad MH (2019) Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab 104:1623–1630PubMedCrossRefGoogle Scholar
  13. 13.
    Lou S, Lv H, Yin P, Li Z, Tang P, Wang Y (2019) Combination therapy with parathyroid hormone analogs and antiresorptive agents for osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 30:59–70PubMedCrossRefGoogle Scholar
  14. 14.
    Díez-Pérez A, Marin F, Eriksen EF, Kendler DL, Krege JH, Delgado-Rodríguez M (2019) Effects of teriparatide on hip and upper limb fractures in patients with osteoporosis: a systematic review and meta-analysis. Bone 120:1–8.  https://doi.org/10.1016/j.bone.2018.09.020 CrossRefPubMedGoogle Scholar
  15. 15.
    Russow G, Jahn D, Appelt J, Märdian S, Tsitsilonis S, Keller J (2018) Anabolic therapies in osteoporosis and bone regeneration. Int J Mol Sci 26:20(1)Google Scholar
  16. 16.
    Khosla S, Hofbauer LC (2017) Osteoporosis treatment: recent developments and ongoing challenges. Lancet Diabetes Endocrinol 5:898–907PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Kanis JA on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK. Available at: https://www.sheffield.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf Accessed 2 April 2019
  18. 18.
    Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046PubMedCrossRefGoogle Scholar
  19. 19.
    Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV, the Advisory Board of the National Osteoporosis Guideline Group (2016) A systematic review of intervention thresholds based on FRAX. A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos 11:25PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Clark P, Denova-Gutiérrez E, Zerbini C, Sanchez A, Messina O, Jaller JJ, Campusano C, Orces CH, Riera G, Johansson H, Kanis JA (2018) FRAX-based intervention and assessment thresholds in seven Latin American countries. Osteoporos Int 29:707–715PubMedCrossRefGoogle Scholar
  21. 21.
    Kanis JA, EV MC, Johansson H, Strom O, Borgstrom F, Oden A, the National Osteoporosis Guideline Group (2008) Case finding for the management of osteoporosis with FRAX® - assessment and intervention thresholds for the UK. Osteoporos Int 19:1395–1408PubMedCrossRefGoogle Scholar
  22. 22.
    Tosteson AN, Melton LJ 3rd, Dawson-Hughes B et al (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19:437–447PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M (2007) Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess; 11: iii–iv, ix–xi, 1–231Google Scholar
  24. 24.
    Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, Gittoes NJ, Harvey I, Harvey N, Heawood A, Holland R, Howe A, Kanis J, Marshall T, O'Neill T, Peters T, Redmond N, Torgerson D, Turner D, McCloskey E (2018) Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet 391(10122):741–747PubMedCrossRefGoogle Scholar
  25. 25.
    Kanis JA, Johansson H, Oden A, McCloskey EV (2011) Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 22:809–816PubMedCrossRefGoogle Scholar
  26. 26.
    Leslie WD, Lix LM, Johansson H, Odén A, McCloskey E, Kanis JA (2011) Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int 22:839–847PubMedCrossRefGoogle Scholar
  27. 27.
    Johansson H, Kanis JA, Odén A, Leslie WD, Fujiwara S, Glüer CC, Kroger H, LaCroix AZ, Lau E, Melton LJ 3rd, Eisman JA, O'Neill TW, Goltzman D, Reid DM, McCloskey E (2014) Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women: a meta-analysis of international cohorts. Calcif Tissue Int 95:428–435PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    McCloskey EV, Odén A, Harvey NC, Leslie WD, Hans D, Johansson H, Barkmann R, Boutroy S, Brown J, Chapurlat R, Elders PJM, Fujita Y, Glüer CC, Goltzman D, Iki M, Karlsson M, Kindmark A, Kurumatani N, Kwok T, Leung J, Lippuner K, Ljunggren Ö, Lorentzon M, Mellström D, Merlijn T, Oei L, Ohlsson C, Pasco J, Rivadeneira F, Rosengren B, Sornay-Rendu E, Szulc P, Tamaki J, Kanis JA (2016) A meta-analysis of trabecular bone score in fracture risk prediction and its dependence on FRAX. J Bone Miner Res 31:940–948PubMedCrossRefGoogle Scholar
  29. 29.
    Leslie WD, Johansson H, Kanis JA, Lamy O, Odén A, McCloskey EV, Hans D (2014) Lumbar spine texture enhances 10-year fracture probability assessment. Osteoporos Int 25:2271–2277PubMedCrossRefGoogle Scholar
  30. 30.
    Leslie WD, Shevroja E, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Hans D (2018) Risk-equivalent T-score adjustment using lumbar spine trabecular bone score (TBS): the Manitoba BMD Registry. Osteoporos Int 29:751–758PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Leslie WD, Lix LM, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA (2015) Adjusting hip fracture probability in men and women using hip axis length: the Manitoba Bone Density Database. J Clin Densitom 19:326–331PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Masud T, Binkley N, Boonen S, Hannan MT, on behalf of the FRAX Position Conference members (2011) Can falls and frailty be used in FRAX? J Clin Densitom 14:194–204PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Johansson H, Odén A, Lorentzon M, McCloskey E, Kanis JA, Harvey NC, Karlsson MK, Mellstrom D (2015) Is the Swedish FRAX model appropriate for immigrants to Sweden? Osteoporos Int 26:2617–2622PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Leslie WD, Rubin MR, Schwartz AZ, Kanis JA (2012) Perspective: diabetes and bone. J Bone Miner Res 27:2231–2237PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Leslie WD, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Hans D (2018) Comparison of methods for improving fracture risk assessment in diabetes: the Manitoba BMD Registry. J Bone Miner Res 33:1923–1930PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Whitlock RH, Leslie WD, Shaw J, Rigatto C, Thorlacius L, Komenda P, Collister D, Kanis JA, Tangri N (2019) The Fracture Risk Assessment Tool (FRAX®) predicts fracture risk in patients with chronic kidney disease. Kidney Int 95:447–454PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Kanis JA, Johansson H, Harvey NC, Lorentzon M, Liu E, Borgström F, McCloskey EV (2019) Correspondence in response to OSIN-D-18-00831 quantifying imminent risk. Osteoporos Int 30:525–526PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    National Institute for Health and Care Excellence (NICE) (2017) Bisphosphonates for treating osteoporosis. Technology appraisal guidance 464. National Institute for Health and Care Excellence, LondonGoogle Scholar
  39. 39.
    Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, KES P, Reid DM, Selby P, Thompson F, Thurston A, Vine N, The National Osteoporosis Guideline Group (NOGG) (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12:43PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Kanis JA, Rizzoli R, Cooper C, Reginster J-Y (2014) Challenges for the development of bone forming agents in Europe. Calcif Tissue Int 94:469–473PubMedCrossRefGoogle Scholar
  41. 41.
    Beck BR, Daly RM, Singh MA, Taaffe DR (2017) Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. J Sci Med Sport 20:438–445PubMedCrossRefGoogle Scholar
  42. 42.
    Giangregorio L, El-Kotob R (2017) Exercise, muscle, and the applied load-bone strength balance. Osteoporos Int 28:21–33PubMedCrossRefGoogle Scholar
  43. 43.
    Bian S, Hu J, Zhang K, Wang Y, Yu M, Ma J (2018) Dairy product consumption and risk of hip fracture: a systematic review and meta-analysis. BMC Public Health 18:165.  https://doi.org/10.1186/s12889-018-5041-5 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Jensen AL, Lomborg K, Wind G, Langdahl BL (2014) Effectiveness and characteristics of multifaceted osteoporosis group education - a systematic review. Osteoporos Int 25:1209–1224PubMedCrossRefGoogle Scholar
  45. 45.
    Morfeld JC, Vennedey V, Müller D, Pieper D, Stock S (2017) Patient education in osteoporosis prevention: a systematic review focusing on methodological quality of randomised controlled trials. Osteoporos Int 28:1779–1803PubMedCrossRefGoogle Scholar
  46. 46.
    Zhou X, Deng H, Shen X, Lei Q (2018) Effect of balance training on falls in patients with osteoporosis: a systematic review and meta-analysis. J Rehabil Med 50:577–581PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    de Souto BP, Rolland Y, Vellas B (2018 Dec 28) Maltais M (2019) Association of long-term exercise training with risk of falls, fractures, hospitalizations, and mortality in older adults: a systematic review and meta-analysis. JAMA Intern Med.  https://doi.org/10.1001/jamainternmed.2018.5406 PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Kemmler W, von Stengel S, Kohl M (2017) Exercise frequency and fracture risk in older adults -how often is enough? Curr Osteoporos Rep 15:564–570PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JCT, Lord SR (2017) Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med 51:1750–1758PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Tricco AC, Thomas SM, Veroniki AA, Hamid JS, Cogo E, Strifler L, Khan PA, Robson R, Sibley KM, MacDonald H, Riva JJ, Thavorn K, Wilson C, Holroyd-Leduc J, Kerr GD, Feldman F, Majumdar SR, Jaglal SB, Hui W, Straus SE (2017) Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. JAMA 318:1687–1699PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    McCloskey E, Kanis JA, Johansson H, Harvey N, Odén A, Cooper A, Cooper C, Francis R, Reid D, Selby P, Davies C, Bowring C, Compston J (2015) FRAX-based assessment and intervention thresholds--an exploration of thresholds in women aged 50 years and older in the UK. Osteoporos Int 26:2091–2099PubMedCrossRefGoogle Scholar
  52. 52.
    Lekamwasam S, Adachi JD, Agnusdei D, Bilezikian J, Boonen S, Borgström F, Cooper C, Diez Perez A, Eastell R, Hofbauer L, Kanis JA, Langdahl BL, Lesnyak O, Lorenc R, McCloskey E, Messina OD, Napoli N, Obermayer-Pietsch B, Ralston SH, Sambrook PN, Silverman S, Sosa M, Stepan J, Suppan G, Wahl DA, Compston JE, for the Joint IOF-ECTS GIO Guidelines Working Group (2012) A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int 23:2257–2276PubMedCrossRefGoogle Scholar
  53. 53.
    Dretakis KE, Dretakis EK, Papakitsou EF, Psarakis S, Steriopoulos K (1998) Possible predisposing factors for the second hip fracture. Calcif Tissue Int 62:366–369PubMedCrossRefGoogle Scholar
  54. 54.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323PubMedCrossRefGoogle Scholar
  55. 55.
    Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res 24:1299–1307PubMedCrossRefGoogle Scholar
  56. 56.
    Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O, Ortsäter G, Libanati C, Toth E (2019) Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int 30:601–609PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, Curtis JR (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30:79–92PubMedCrossRefGoogle Scholar
  58. 58.
    Kanis JA, Johansson H, Odén A, Harvey NC, Gudnason V, Sanders K, Sigurdsson G, Siggeirsdottir K, Borgström F, McCloskey EV (2018) Characteristics of recurrent fractures. Osteoporos Int 29:1747–1757PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Johansson H, Siggeirsdottir K, Harvey NC, McCloskey EV, Gudnason V, Sigurdsson G, Lorentzon M, Liu E, Kanis JA (2019) Adjusting FRAX for imminent risk. Osteoporos Int, abstract in press.Google Scholar
  60. 60.
    Cosman F, Nieves JW, Dempster DW (2017) Treatment sequence matters: anabolic and antiresorptive therapy for osteoporosis. J Bone Miner Res 32(198–202):270Google Scholar
  61. 61.
    Kanis JA, Cooper C, Rizzoli R, Abrahamsen B, Al-Daghri NM, Brandi ML, Cannata-Andia J, Cortet B, Dimai HP, Ferrari S, Hadji P, Harvey NC, Kraenzlin M, Kurth A, McCloskey E, Minisola S, Thomas T, Reginster JY (2017) Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int 28:2023–2034PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Kanis JA, Cooper C, Rizzoli R, Reginster J-Y (2018) Review of the guideline of the American College of Physicians on the treatment of osteoporosis. Osteoporos Int 29:1505–1510PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Leder BZ, Tsai JN, Neer RM, Uihlein AV, Wallace PM, BurnettBowie SA (2016) Response to therapy with teriparatide, denosumab, or both in postmenopausal women in the DATA (denosumab and teriparatide administration) study randomized controlled trial. J Clin Densitom 19:346–351PubMedCrossRefGoogle Scholar
  64. 64.
    Bone HG, Cosman F, Miller PD, Williams GC, Hattersley G, Hu MY, Fitzpatrick LA, Mitlak B, Papapoulos S, Rizzoli R, Dore RK, Bilezikian JP, Saag KG (2018) ACTIVExtend: 24 months of alendronate after 18 months of abaloparatide or placebo for postmenopausal osteoporosis. J Clin Endocrinol Metab 103:2949–2957CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • J. A. Kanis
    • 1
    • 2
    Email author
  • N. C. Harvey
    • 3
  • E. McCloskey
    • 1
    • 4
  • O. Bruyère
    • 5
  • N. Veronese
    • 6
  • M. Lorentzon
    • 2
    • 7
    • 8
  • C. Cooper
    • 3
    • 9
  • R. Rizzoli
    • 10
  • G. Adib
    • 11
  • N. Al-Daghri
    • 12
  • C. Campusano
    • 13
  • M. Chandran
    • 14
  • B. Dawson-Hughes
    • 15
  • K. Javaid
    • 9
  • F. Jiwa
    • 16
  • H. Johansson
    • 1
    • 2
  • J. K. Lee
    • 17
  • E. Liu
    • 2
  • D. Messina
    • 18
  • O. Mkinsi
    • 19
  • D. Pinto
    • 20
    • 21
  • D. Prieto-Alhambra
    • 9
    • 22
  • K. Saag
    • 23
  • W. Xia
    • 24
  • L. Zakraoui
    • 25
  • J. -Y. Reginster
    • 12
    • 26
  1. 1.Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  2. 2.Mary McKillop Health InstituteAustralian Catholic UniversityMelbourneAustralia
  3. 3.MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
  4. 4.MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing MellanbySheffieldUK
  5. 5.World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
  6. 6.National Research Council, Neuroscience InstituteAging BranchPadovaItaly
  7. 7.Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine and Clinical Nutrition, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  8. 8.Region Västra Götaland, Geriatric Medicine ClinicSahlgrenska University HospitalGothenburgSweden
  9. 9.NIHR Musculoskeletal Biomedical Research UnitUniversity of OxfordOxfordUK
  10. 10.Service of Bone DiseasesGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  11. 11.Syrian National Osteoporosis SocietyDamascusSyria
  12. 12.Chair for Biomarkers of Chronic Diseases, Biochemistry Dept., College of ScienceKing Saud UniversityRiyadhKingdom of Saudi Arabia
  13. 13.Clinica Universidad de los Andes and Faculty of MedicineUniversidad de los AndesSantiagoChile
  14. 14.Osteoporosis and Bone Metabolism Unit, Department of EndocrinologySingapore General Hospital, ACADEMIASingaporeSingapore
  15. 15.Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts UniversityBostonUSA
  16. 16.Chair of the Committee of Patients Societies at the International Osteoporosis FoundationOsteoporosis CanadaTorontoCanada
  17. 17.Beacon International Specialist CentrePetaling JayaMalaysia
  18. 18.IRO Medical Research Center, Buenos Aires and Rheumatology sectionCosme ArgerichBuenos AiresArgentina
  19. 19.Department of RheumatologyIbn Rochd University HospitalCasablancaMorocco
  20. 20.Department of Physical TherapyMarquette UniversityMilwaukeeUSA
  21. 21.Department of Medical Social Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  22. 22.GREMPAL Research Group, CIBERFes and Idiap Jordi GolInstituto de Salud Carlos III and Universitat Autonoma de BarcelonaBarcelonaSpain
  23. 23.University of Alabama at BirminghamBirminghamUSA
  24. 24.Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
  25. 25.Service de RhumatologieUniversity Tunis Manar and Hôpital Mongi-Slimla MarsaTunisia
  26. 26.Department of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium

Personalised recommendations