In 2018 the International Osteoporosis Foundation (IOF) and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) published the updated European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Now, the newly published position paper ‘Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures’ summarizes the guidance in an international setting, with a focus on the categorisation of risk as a strategy to target therapeutic interventions.

The publication reflects the outcomes of a consensus meeting organized by ESCEO and IOF, involving experts from 17 countries. It includes easy-to-use algorithms which illustrate possible decision pathways for the management of postmenopausal osteoporosis, based on the absolute risk of fracture (FRAX^®) and an assessment strategy permitting the classification of low, high and very high risk of osteoporotic fractures.

Professor John A. Kanis, lead author and IOF honorary president, stated: "Fractures related to osteoporosis are a major cause of morbidity and early mortality. We now know that the risk of a subsequent fracture is acute immediately after a first fracture. This clearly points to the need for early intervention for secondary fracture prevention, and to the use of agents that have the most rapid effect on fracture reduction in patients at very high risk.”

The rationale for the more refined characterisation of risk is to offer the most appropriate interventions to the patient. For example, initial treatment recommendations for women at high risk might most suitably be with an inhibitor of bone resorption. In contrast, women at very high risk (or ‘imminent risk’ of fracture) might be more suitably treated with an anabolic treatment followed thereafter by an inhibitor of bone resorption. 

Professor Jean-Yves Reginster, ESCEO president and co-author, added: "The publication addresses the need for succinct guidance that will help clinicians identify and treat women at the very highest risk as early as possible. As well, it is intended as a platform on which specific national guidelines can be developed to characterise fracture risk and direct interventions.”

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Further reading:

Kanis, J.A., Harvey, N.C., McCloskey, E. et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int (2019). https://doi.org/10.1007/s00198-019-05176-3
https://rdcu.be/bW6Ow

Kanis, J., Cooper, C., Rizzoli, R. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int (2019) 30: 3. https://doi.org/10.1007/s00198-018-4704-5

Kanis, J.A., Cooper, C., Rizzoli, R. et al. Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int (2019) 104: 235. https://doi.org/10.1007/s00223-018-00512-x

Fracture Risk Assessment Tool (FRAX) 

About IOF: The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as more than 250 patient, medical and research societies in 100 nations, work together to make fracture prevention and healthy mobility a worldwide heath care priority.

About ESCEO: The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis & Musculoskeletal Diseases (ESCEO) is a non-profit organization, dedicated to a close interaction between clinical scientists dealing with rheumatic disorders, pharmaceutical industry developing new compounds in this field, regulators responsible for the registration of such drugs and health policy makers, to integrate the management of osteoporosis and osteoarthritis within the comprehensive perspective of health resources utilization. The objective of ESCEO is to provide practitioners with the latest clinical and economic information, allowing them to organize their daily practice, in an evidence-based medicine perspective, with a cost-conscious perception.