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Osteoporosis International
Published in: Osteoporosis International 12/2020

Open Access 01-12-2020 | Osteoporosis | Original Article

Is a treat-to-target strategy in osteoporosis applicable in clinical practice? Consensus among a panel of European experts

Authors: T. Thomas, E. Casado, P. Geusens, W. F. Lems, J. Timoshanko, D. Taylor, L. C. Hofbauer

Published in: Osteoporosis International | Issue 12/2020

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Abstract

Summary

A panel of European experts was convened to establish consensus on a treat-to-target strategy in osteoporosis. Panellists agreed that the ultimate goals of treating osteoporosis are recovering pre-fracture functional level and reducing subsequent fracture risk; there was consensus that total hip bone mineral density is currently the most appropriate treatment target in clinical practice.

Introduction

A modified Delphi approach was convened to establish consensus among European experts on best practice management for patients with fragility fractures and whether a treat-to-target (T2T) strategy is applicable in osteoporosis.

Methods

A panel of 12 clinical experts (from eight European countries) voted on 13 final statements relating to a T2T strategy for osteoporosis across three rounds of blinded, remotely conducted electronic surveys (Likert scale: ‘strongly disagree’, ‘disagree’, ‘unable to answer’, ‘agree’, ‘strongly agree’). When panellists disagreed, they were asked how the statement could be adjusted to allow for a positive response, which was used to refine the statement for the following round. Consensus was defined as ≥ 75% agreement with a statement. Panellists were selected by UCB Pharma, which provided financial and logistical support.

Results

Consensus was reached for 13/13 statements. Panellists agreed that the most important goals for fragility fracture patients are recovery of pre-fracture functional level and reduction of subsequent fracture risk. There was also consensus that a T2T strategy is applicable to osteoporosis and that bone mineral density (BMD) is currently the most clinically appropriate target. With regard to the definition of a specific BMD treatment target and timeframes applicable to T2T in osteoporosis, no clear consensus was reached; panellists emphasised that these would need to be individually determined.

Conclusions

According to a panel of European experts, the main goals of fracture management are to recover pre-fracture functional level and reduce fracture risk. Total hip BMD seems to be the most clinically appropriate treatment target within a T2T strategy.
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Metadata
Title
Is a treat-to-target strategy in osteoporosis applicable in clinical practice? Consensus among a panel of European experts
Authors
T. Thomas
E. Casado
P. Geusens
W. F. Lems
J. Timoshanko
D. Taylor
L. C. Hofbauer
Publication date
01-12-2020
Publisher
Springer London
Published in
Osteoporosis International / Issue 12/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-020-05569-9

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