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Purpose of Review
Treat-to-target (goal-directed therapy) has been proposed as a strategy to assist clinicians in selecting the most appropriate initial treatment for osteoporosis and guiding subsequent decisions to continue, change, or stop treatment. This is a review of the current medical evidence regarding treatment targets and potential clinical applications in managing patients with osteoporosis.
Analyses of randomized placebo-controlled trials of approved agents to treat osteoporosis have generally shown that larger increases in bone mineral density are associated with greater reduction in fracture risk. Achievement of T-scores > −2.5 to −2.0 with treatment appears to provide little additional fracture protection.
The paradigm of treat-to-target is aimed at enhancing and individualizing the care of patients with osteoporosis. Based on the best available data, the most promising target is T-score > −2.5. More data are needed to validate the clinical utility of treat-to-target for osteoporosis.
KeywordsOsteoporosis Treatment Target Goal Goal-directed
Compliance with Ethical Standards
Conflict of Interest
E. Michael Lewiecki reports grants and personal fees from Amgen, grants and personal fees from Merck, grants and personal fees from Lilly, personal fees from Radius, during the conduct of the study.
Consulting/advisory board fees from Amgen, Eli Lilly, Merck, Alexion, Shire; grant/research support from Amgen, Merck, Eli Lilly; speaking fees from Shire, Alexion.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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