هشاشة العظام مع الكسر المرضي عندما لم تحقق البيسفوسفونات من الخط الأول أو علاج مثبطات ارتشاف العظام الأهداف العلاجية

References

• Use of teriparatide and abaloparatide is still recommended for 18–24 months owing to limited evidence for safety and efficacy beyond this period.
• Although residual effects on fracture risk reduction exist for up to 18 months after cessation of therapy, teriparatide or abaloparatide should be followed by anti-resorptives (raloxifene, bisphosphonates, or denosumab) after discontinuation to consolidate or further extend BMD gains.
• BMD gains are reversed nearly to baseline over one year following discontinuation of romosozumab and should be prevented by transition to anti-resorptive therapy.
• Studies show that transitioning from teriparatide or romosozumab to denosumab leads to continued BMD increases, with the romosozumab-to-denosumab sequence yielding gains equivalent to seven years of denosumab alone, as seen in the FRAME and FREEDOM studies.
• Bisphosphonates also help to maintain or increase BMD after osteoanabolic therapy, as observed in the ACTIVExtend and ARCH trials.
• On teriparatide or abaloparatide, aim for P1NP above reference range or change greater than LSC.
• In patients with low T-scores, a target of T ≥ −2.5 is generally adopted as an appropriate threshold for discontinuation of therapy, on the basis of the FLEX and HORIZON-PFT trials, and endorsed by the latest American Society of Bone and Mineral Research guidance on goal directed osteoporosis treatment.
• Experts recommend an improvement in total hip T-score of at least 0.2 units (3%) and in lumbar spine T-score of at least 0.5 units (6%), on the basis of reasonable chances of attaining such increments over three years by most therapies, including anti-resorptives.