November 10-15

The official news source of

ACR Convergence 2023

San Diego, CA

Home // Treat-to-target concept emerges in managing 
osteoporosis, fracture risk for patients

Treat-to-target concept emerges in managing 
osteoporosis, fracture risk for patients


4 minutes

A panel will update attendees Monday on various bone-related disease issues, including current and investigational medications for treatment of osteoporosis, pediatric bone disease and its progression into adulthood, and osteonecrosis in patients with rheumatic disease.

E. Michael Lewiecki, MD
E. Michael Lewiecki, MD

During Throw Me a Bone!: Update on Important Concepts in Bone-Related Diseases, held from 2:30 – 4:00 pm in Room 20 D, E. Michael Lewiecki, MD, will discusss trategies to address the growing osteoporosis “treatment gap” and reduce the risk of fractures related to osteoporosis. Dr. Lewiecki is Director of the New Mexico Clinical Research & Osteoporosis Center and Director of the Bone Health TeleECHO program at the University of New Mexico Health Sciences Center in Albuquerque.

“Globally, there are about 200 million people with osteoporosis and about nine million fractures related to osteoporosis in the world every year,” Dr. Lewiecki said. “And despite the fact that we have excellent medications to reduce fracture risk and great tools to evaluate fracture risk to help us decide who needs to be treated, it’s vastly undertreated virtually around the world.”

Dr. Lewiecki’s topics will include the emerging treat-to-target concept in managing osteoporosis and fracture risk.

“Typically, when we treat for osteoporosis, we’ll start patients on the least-expensive drug that works fine for most people, such as generic alendronate,” he said. “In the past, we’ve generally been happy if the patient responds to treatment and their bone density remains stable or goes up a little bit, but we shouldn’t be satisfied if their risk of fracture still remains very high. Treat-to-target for osteoporosis is an emerging concept that addresses this issue.”

Another emerging concept is the implementation of fracture liaison services in hospitals to identify and manage patients at risk for future fractures.

“The idea is to have a systematic strategy in place to identify fracture patients in the hospital and have them seen by a fracture liaison, usually a nurse practitioner, who will help to educate the patient and the family about the possibility of osteoporosis and future fracture risk,” Dr. Lewiecki said. “The liaison can evaluate the patient, enter that patient into a registry, and follow them after they’re discharged to see that their physician continues the evaluation and appropriately treats that patient to reduce the risk of another fracture.”

Finally, Dr. Lewiecki will talk about the Bone Health TeleECHO program, a telementoring initiative developed at the University of New Mexico, in which healthcare professionals from around the country participate in weekly teleconferencing sessions to discuss patient cases and learn from each other best practices for the treatment of osteoporosis.

Catherine Gordon, MD, MSc
Catherine Gordon, MD, MSc

Catherine Gordon, MD, MSc, will update attendees on pediatric bone diseases and considerations about treating these patients as they transition into adulthood. Dr. Gordon is Professor in the Department of Pediatrics, Director of the Division of Adolescent and Transition Medicine, and Rauh Chair of Adolescent Medicine at the University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center in Ohio.

“Pediatricians often think about prevention, and that’s especially important in the area of bone health because peak bone mass is achieved at the end of adolescence,” Dr. Gordon said. “Pediatric patients with rheumatic disease are often treated with glucocorticoids, which can impact bone turnover and lead to bone loss. As these patients become adults, they can be at risk for a compromised peak bone mass and for early osteoporosis and fractures.”

Dr. Gordon said that as part of general screening, pediatric patients with rheumatic disease and who may be at high risk for low bone density and fractures should undergo routine radiographic imaging as well as dual-energy X-ray absorptiometry to establish a baseline bone density measurement.

“It’s essential to think about what is happening in these young patients with respect to their bone density as they’re growing and as they’re going through puberty,” she said. “It’s important to note, for example, if they’re not growing or not going through puberty, as the sex steroids that are produced during puberty and growth hormones are very important for the accrual of peak bone mass.”

Stuart Goodman, MD, PhD
Stuart Goodman, MD, PhD

The final presenter of the symposium, Stuart Goodman, MD, PhD, will review the pathophysiology and clinical management of osteonecrosis. Dr. Goodman is the Robert L. and Mary Ellenburg Professor of Surgery and Professor with Tenure in the Department of Orthopaedic Surgery at Stanford University in Palo Alto, CA.

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