##common.pageHeaderLogo.altText##

Review article: Medical guidelines

Vol. 150 No. 3940 (2020)

2020 recommendations for osteoporosis treatment according to fracture risk from the Swiss Association against Osteoporosis (SVGO)

  • Serge Ferrari
  • Kurt Lippuner
  • Olivier Lamy
  • Christian Meier
Cite this as:
Swiss Med Wkly. 2020;150:w20352
Published
29.09.2020

Summary

Current guidelines from the Swiss Association against Osteoporosis (SVGO) dating from 2015 recommend therapy for men and women at increased fracture risk, specifically those with a vertebral or hip fracture; those with bone mineral density T-score <−2.5 at spine or hip; and those with a high 10-year probability of a major osteoporotic fracture as calculated by using FRAX. However no specific treatment recommendations have been made so far in our country to guide therapy according to the baseline level of risk. We now define four risk subgroup categories (imminent and very high, high, moderate, low) and propose an algorithm for osteoporosis therapy according to the level of fracture risk.

References

  1. Svedbom A, Ivergård M, Hernlund E, Rizzoli R, Kanis JA. Epidemiology and economic burden of osteoporosis in Switzerland. Arch Osteoporos. 2014;9(1):187. doi:.https://doi.org/10.1007/s11657-014-0187-y
  2. Suhm N, Lamy O, Lippuner K ; OsteoCare study group. Management of fragility fractures in Switzerland: results of a nationwide survey. Swiss Med Wkly. 2008;138(45-46):674–83.
  3. Meier C, Uebelhart B, Aubry-Rozier B, Birkhäuser M, Bischoff-Ferrari HA, Frey D, et al. Osteoporosis drug treatment: duration and management after discontinuation. A position statement from the SVGO/ASCO. Swiss Med Wkly. 2017;147:w14484.
  4. Kanis JA, Johansson H, Odén A, Harvey NC, Gudnason V, Sanders KM, et al. Characteristics of recurrent fractures. Osteoporos Int. 2018;29(8):1747–57. doi:.https://doi.org/10.1007/s00198-018-4502-0
  5. Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, et al. Risk of subsequent fracture after prior fracture among older women. Osteoporos Int. 2019;30(1):79–92. doi:.https://doi.org/10.1007/s00198-018-4732-1
  6. Pinedo-Villanueva R, Charokopou M, Toth E, Donnelly K, Cooper C, Prieto-Alhambra D, et al. Imminent fracture risk assessments in the UK FLS setting: implications and challenges. Arch Osteoporos. 2019;14(1):12. doi:.https://doi.org/10.1007/s11657-019-0569-2
  7. Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, et al. 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. 2018;391(10117):230–40. doi:.https://doi.org/10.1016/S0140-6736(17)32137-2
  8. Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, et al. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. N Engl J Med. 2017;377(15):1417–27. doi:.https://doi.org/10.1056/NEJMoa1708322
  9. McClung MR, Grauer A, Boonen S, Bolognese MA, Brown JP, Diez-Perez A, et al. Romosozumab in postmenopausal women with low bone mineral density. N Engl J Med. 2014;370(5):412–20. doi:.https://doi.org/10.1056/NEJMoa1305224
  10. Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int. 2020;31(1):1–12. doi:.https://doi.org/10.1007/s00198-019-05176-3
  11. Huntjens KM, van Geel TA, van Helden S, van den Bergh J, Willems P, Winkens B, et al. The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk and mortality. BMC Musculoskelet Disord. 2013;14(1):121. doi:.https://doi.org/10.1186/1471-2474-14-121
  12. Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA, et al.; ACTIVE Study Investigators. Effect of Abaloparatide vs Placebo on New Vertebral Fractures in Postmenopausal Women With Osteoporosis: A Randomized Clinical Trial. JAMA. 2016;316(7):722–33. doi:.https://doi.org/10.1001/jama.2016.11136
  13. Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al.; HORIZON Recurrent Fracture Trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357(18):1799–809. doi:.https://doi.org/10.1056/NEJMoa074941
  14. Boonen S, Adachi JD, Man Z, Cummings SR, Lippuner K, Törring O, et al. Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab. 2011;96(6):1727–36. doi:.https://doi.org/10.1210/jc.2010-2784
  15. Gnant M, Pfeiler G, Dubsky PC, Hubalek M, Greil R, Jakesz R, et al.; Austrian Breast and Colorectal Cancer Study Group. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2015;386(9992):433–43. doi:.https://doi.org/10.1016/S0140-6736(15)60995-3
  16. Smith MR, Egerdie B, Hernández Toriz N, Feldman R, Tammela TL, Saad F, et al., Denosumab HALT Prostate Cancer Study Group. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med. 2009;361(8):745–55. doi:.https://doi.org/10.1056/NEJMoa0809003
  17. Meier C, Lamy O, Krieg MA, Mellinghoff HU, Felder M, Ferrari S, et al. The role of teriparatide in sequential and combination therapy of osteoporosis. Swiss Med Wkly. 2014;144:w13952. doi:.https://doi.org/10.4414/smw.2014.13952