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Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Tai TW 1 , Chen HY 2 , Shih CA 1 , Huang CF 3 , McCloskey E 4 , Lee JK 5 Show all authors , Yeap SS 6 , Cheung CL 7 , Charatcharoenwitthaya N 8 , Jaisamrarn U 9 , Kuptniratsaikul V 10 , Yang RS 2 , Lin SY 11 , Taguchi A 12 , Mori S 13 , Li-Yu J 14 , Ang SB 15 , Chan DC 16 , Chan WS 17 , Ng H 18 , Chen JF 19 , Tu ST 20 , Chuang HH 21 , Chang YF 22 , Chen FP 23 , Tsai KS 24 , Ebeling PR 25 , Marin F 26 , Nistal Rodríguez FJ 27 , Shi H 28 , Hwang KR 29 , Kim KK 30 , Chung YS 31 , Reid IR 32 , Chandran M 33 , Ferrari S 34 , Lewiecki EM 35 , Hew FL 6 , Ho-Pham LT 36 , Nguyen TV 37 , Nguyen VH 38 , Lekamwasam S 39 , Pandey D 40 , Bhadada S 41 , Chen CH 11 , Hwang JS 42 , Wu CH 22

Affiliations 

  • 1 Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 2 Department of Orthopedic Surgery, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
  • 3 Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan
  • 4 Division of Clinical Medicine, School of Medicine and Population Health, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, UK
  • 5 Department of Orthopaedics, Beacon Hospital, Petaling Jaya, Selangor, Malaysia
  • 6 Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
  • 7 Department of Pharmacology and Pharmacy, Centre for Genomic Sciences, The University of Hong Kong, Pokfulam, Hong Kong
  • 8 Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Thammasat University, Thailand
  • 9 Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 10 Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 11 Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 12 Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Nagano, Japan
  • 13 Bone and Joint Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
  • 14 Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
  • 15 Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, Singapore
  • 16 Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
  • 17 Department of Internal Medicine Orthopaedics, Centro Hospitalar Conde de Sao Januario, Macao, China
  • 18 Department of Internal Medicine, Centro Hospitalar Conde de Sao Januario, Macau, China
  • 19 Division of Metabolism and Endocrinology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  • 20 Division of Endocrinology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
  • 21 Department of Family Medicine, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  • 22 Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 23 Department of Obstetrics and Gynecology, Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
  • 24 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • 25 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  • 26 Department of Endocrinology, Hospital Universitario Quironsalud, Madrid, Spain
  • 27 Department Orthopaedic Surgery and Traumatology, Hospital Universitario Rio Hortega, Valladolod, Spain
  • 28 National Center for Orthopedics, Department of Orthooedics, Shanghai 6th People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 29 Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
  • 30 Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
  • 31 Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
  • 32 Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  • 33 Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
  • 34 Service of Bone Diseases, Department of Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
  • 35 New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
  • 36 BioMedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
  • 37 Tâm Anh Research Institute, Ho Chi Minh City, Viet Nam
  • 38 Orthopaedic Center, Hue Central Hospital, Hue City, Viet Nam
  • 39 Department of Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka
  • 40 Koshi Hospital, Biratnagar, Nepal
  • 41 Department of Endocrinology, PGIMER, Chandigarh, India
  • 42 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
Osteoporos Sarcopenia, 2024 Mar;10(1):3-10.
PMID: 38690538 DOI: 10.1016/j.afos.2024.02.001

Abstract

OBJECTIVES: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition. The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach.

METHODS: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and antiresorptive agents in sequential therapy approaches.

RESULTS: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to antiresorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for individuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment.

CONCLUSIONS: This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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