Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO)
Arch. endocrinol. metab. (Online)
;
66(5): 591-603, Sept.-Oct. 2022. tab
Article
in English
|
LILACS-Express
| LILACS
| ID: biblio-1420087
ABSTRACT
ABSTRACT Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.
Full text:
Available
Index:
LILACS (Americas)
Type of study:
Controlled clinical trial
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Etiology study
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Practice guideline
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Risk factors
Country/Region as subject:
South America
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Brazil
Language:
English
Journal:
Arch. endocrinol. metab. (Online)
Journal subject:
Endocrinology
/
Metabolism
Year:
2022
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Centro Paulista de Investigação Clínica/BR
/
Santa Casa de Belo Horizonte/BR
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Universidade Federal da Paraíba/BR
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Universidade Federal de São Paulo/BR
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Universidade Federal do Ceará/BR
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Universidade Federal do Rio de Janeiro/BR
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Universidade de Pernambuco/BR
/
Universidade de São Paulo/BR
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