Current Concepts in the Management of Osteoporosis, with E. Michael Lewiecki, MD

When suspecting osteoporosis, E. Michael Lewiecki, MD, director of New Mexico Clinical Research & Osteoporosis Center, explained the first step is confirmation through a bone density test, particularly in women aged 65 and older, younger postmenopausal women with risk factors, and men aged 70 and older or 50 to 70 with risk factors. These risk factors include family history, prior fractures, smoking, or medication use harmful to bones.

Once bone density is assessed, the next stage involves estimating fracture risk, typically guided by a T-score of -2.5 or lower, indicating high fracture risk warranting pharmacological intervention. For patients with osteopenia (T-scores between -1.0 and -2.5), fracture risk algorithms like the Fracture Risk Assessment Tool (FRAX ) are used. If the 10-year probability of major osteoporotic fracture exceeds 20% or hip fracture risk is over 3%, pharmacological therapy is recommended to reduce fracture risk.

In an interview with HCPLive, Lewiecki further discusses his upcoming 2024 CCR East presentation on the current concepts of the management of osteoporosis.

Modern clinical guidelines place fracture risk stratification into high, moderate, or very high categories, which determine the treatment aggressiveness accordingly. For low-risk patients, nonpharmacological approaches centered on lifestyle modifications and nutritional support are preferred. High-risk individuals often start with antiresorptive medications like bisphosphonates or denosumab, while those at very high risk may benefit from osteoanabolic therapies. Although bisphosphonates and denosumab are effective, anabolic agents offer superior fracture risk reduction in high-risk patients.

Despite advancements in fracture risk assessment and treatment strategies, Lewiecki says the development of new osteoporosis drugs has slowed due to the cost and complexity of large clinical trials focused on fracture endpoints. Future prospects depend on potential changes in US Food and Drug Administration (FDA) guidelines for clinical trial designs, which might encourage the emergence of novel treatments. However, according to Lewiecki, no imminent breakthroughs are anticipated in the near future.

Ultimately, the management of osteoporosis underscores the importance of risk assessment, personalized treatment plans, and ongoing monitoring to mitigate fracture risk effectively and improve patient outcomes.

Disclosures: Lewiecki has no disclosures to report.