title: Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis.
abstract: The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goal-directed treatment, a treatment goal would first be established and choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > -2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment. Progress toward reaching the patient's goal would be periodically and systematically assessed by estimating the patient's compliance with treatment, reviewing fracture history, repeating vertebral imaging when indicated, and repeating measurement of bone mineral density (BMD). Using these data, a decision would be made to stop, continue, or change therapy. Some of these approaches can now be applied to clinical practice. However, the application of goal-directed treatment cannot be fully achieved until medications are available that provide greater increases in BMD and greater reduction in fracture risk than those that are currently approved; only then can patients with very high fracture risk and very low BMD achieve such goals. Furthermore, assessing future fracture risk in patients on treatment requires a new assessment tool that accurately captures the change in fracture risk associated with treatment and should also be sensitive to the importance of recent fractures as predictors of imminent fracture risk. Lastly, evidence is needed to confirm that selecting and switching treatments to achieve goals reduces fracture risk more effectively than current standard care. © 2016 American Society for Bone and Mineral Research.
authors.affiliation: California Pacific Medical Center, Research Institute, San Francisco, CA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.affiliation: Helen Hayes Hospital and Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Cosman
authors.affiliation: New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
authors.forename: E Michael
authors.initials: EM
authors.lastname: Lewiecki
authors.affiliation: Park Nicollet Institute for Research and Education, Division of Rheumatology, Minneapolis, MN, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.affiliation: University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
authors.affiliation: University of Iowa, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Brown
authors.affiliation: University of Toronto, Faculty of Medicine, Ontario, Canada.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.affiliation: Foundation for Osteoporosis Research and Education, Oakland, CA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Cody
authors.affiliation: University of Southampton, MRC Lifecourse Epidemiology Unit, Southhampton, United Kingdom.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Hospital del Mar-IMIM-Universitat Autònoma de Barcelona and RETICEF, Instituto Carlos III, Spain, Internal Medicine - Infectious Diseases, Barcelona, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Diez-Perez
authors.affiliation: University of Sheffield, Human Metabolism, England, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.affiliation: Philipps-University of Marburg, Department of Endocrinology, Osteoporosis, and Reproductive Medicine, Marburg, Germany.
authors.forename: Peyman
authors.initials: P
authors.lastname: Hadji
authors.affiliation: National Center for Geriatrics and Gerontology, Obu City, Aichi Prefecture, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hosoi
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Jan De Beur
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Risa
authors.initials: R
authors.lastname: Kagan
authors.affiliation: Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
authors.affiliation: University of Auckland, Department of Medicine, Auckland, New Zealand.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Reid
authors.affiliation: Brigham and Women's Hospital, Division of Rheumatology, Boston, MA, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.affiliation: National Osteoporosis Foundation, Arlington, VA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Randall
mesh_terms: D000066491:Clinical Decision-Making; D006040:Goals; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000453:epidemiology; D058028:Research Report
keywords: GOAL; OSTEOPOROSIS; TARGET; TREAT-TO-GOAL; TREAT-TO-TARGET; TREATMENT