Imminent Fracture Risiko – Folgen für die Sequenztherapie

Zusammenfassung

Das „Imminente Frakturrisiko“ war in den vergangenen Jahren Thema diverser Publikationen. Dabei ist das Thema eines akzentuiert erhöht liegenden Frakturrisikos nach Fraktur über einen Zeitraum von max. 2 Jahren nicht neu, da Frakturrisikogradienten nach Fraktur nicht linear mit der Zeit verlaufen. Grund der aufgeflammten Diskussion ist die Möglichkeit der erweiterten therapeutischen Optionen durch Zulassung eines zweiten osteoanabol wirkenden Medikamentes. Die osteoanabole Therapie als optimale Therapiesequenz nach Fraktur in der Zeit des imminent erhöht liegenden Frakturrisikos wird im Konsens international empfohlen. Die Leitlinienaktualisierung der S3 Leitlinie zur Diagnostik und Therapie der Osteoporose fasst die Daten zum imminenten Frakturrisiko in den Empfehlungen zur Differentialtherapie zusammen, der Hintergrund der Empfehlungen soll in dem Beitrag dargelegt werden.

Abstract

The imminent fracture risk has been the subject of various publications in recent years. The topic of an accentuated increased fracture risk after fractures over a maximum period of 2 years is nothing entirely new, as it has been quite well known that fracture risk gradients after fractures do not run linear over time. The reason for the renewed discussion is the possibility of expanding the therapeutic options through the approval of a second osteoanabolic agent. The international consensus is, that osteoanabolic therapy is the optimal treatment sequence after a fracture during the period of immediately increased fracture risk. The guideline update of the S3 guideline on the diagnosis and treatment of osteoporosis summarizes the data on the imminent fracture risk in the recommendations for differential therapy.

Schlüsselwörter

Imminentes Frakturrisiko - Sequenztherapie - Osteoporose - Hochrisikopatienten - Osteoanabole Therapie

Keywords

Osteoporosis - Sequential therapy - anabolic agent - imminent - fracture risk

Publication History

Received: 18 December 2023

Accepted: 08 March 2024

Article published online:
16 May 2024

• Literatur

• 1 Lippuner K, Johansson H, Kanis JA. et al. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporosis international 2009; 20: 1131-1140
• 2 Cauley JA, Wampler NS, Barnhart JM. et al. Incidence of fractures compared to cardiovascular disease and breast cancer: the Women’s Health Initiative Observational Study. Osteoporosis international 2008; 19: 1717-1723
• 3 Roux C, Briot K. Imminent fracture risk. Osteoporos Int 2017; 28: 1765-1769
• 4 Lindsay R, Silverman SL, Cooper C. et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001; 285: 320-323
• 5 van Geel TA, van Helden S, Geusens PP. et al. Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 2009; 68: 99-102
• 6 Kanis JA, Johansson H, Odén A. et al. Characteristics of recurrent fractures. Osteoporosis International 2018; 29: 1747-1757
• 7 Hadji P, Schweikert B, Kloppmann E. et al. Osteoporotic fractures and subsequent fractures: imminent fracture risk from an analysis of German real-world claims data. Arch Gynecol Obstet 2021; 304: 703-712
• 8 Christensen ER, Clausen A, Petersen TG. et al. Excess mortality following a first and subsequent osteoporotic fracture: a Danish nationwide register-based cohort study on the mediating effects of comorbidities. RMD open 2023; 9: e003524
• 9 Haentjens P, Magaziner J, Colón-Emeric CS. et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010; 152: 380-90
• 10 Cooper C, Atkinson EJ, Jacobsen SJ. et al. Population-based study of survival after osteoporotic fractures. American journal of epidemiology 1993; 137: 1001-1005
• 11 Curtis EM, Reginster JY. , Al-Daghri et al. Management of patients at very high risk of osteoporotic fractures through sequential treatments. Aging Clinical and Experimental Research 2022; 34: 695-714
• 12 Laura I, Felicia B, Alexia C. et al. Which treatment to prevent an imminent fracture?. Bone reports 2021; 15: 101105
• 13 Saag KG, Petersen J, Brandi ML. et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. New England Journal of Medicine 2017; 377: 1417-1427
• 14 Kendler DL, Marin F, Zerbini CA. et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. The Lancet 2018; 391: 230-240
• 15 Miller PD, Lewiecki EM, Krohn K. et al. Teriparatide: Label changes and identifying patients for long-term use. Cleveland Clinic Journal of Medicine 2021; 88: 489-493
• 16 Ferrari SL, Lippuner K, Lamy O. et al. 2020 recommendations for osteoporosis treatment according to fracture risk from the Swiss Association against Osteoporosis (SVGO). Swiss medical weekly 2020; 150: w20352
• 17 Scottish Intercollegiate Guidelines Network (SIGN). Management of osteoporosis and the prevention of fragility fractures. Edinburgh: SIGN; 2021. (SIGN publication no. 142). [January 2021]. Available from URL http://www.sign.ac.uk
• 18 Shoback D, Rosen CJ, Black D. et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society guideline update. The Journal of Clinical Endocrinology & Metabolism 2020; 105: 587-594