EMERGING TREATMENTS AND ALGORITHM FOR FRAGILITY FRACTURES INTRODUCTION Despite a wide range of effective anti-osteoporosis medications and a growing elderly population, the proportion of patients receiving adequate...
EMERGING TREATMENTS AND ALGORITHM FOR FRAGILITY FRACTURES INTRODUCTION Despite a wide range of effective anti-osteoporosis medications and a growing elderly population, the proportion of patients receiving adequate secondary fracture prevention is falling. Fragility fractures were covered in depth in with the introduction, nonpharmacologic and pharmacologic treatment options. An update will be provided here on emerging treatments within the past few years and a new algorithm will be provided.
Case Vignette A 20 year old female cross-country runner presents to your clinic for preseason to try to maximize her performance. Her primary care order ordered a bone density test (DEXA) and asked you about the results and your recommendations. Which of the following statements and recommendations would be true?
A) Z-score -2.3; further studies warranted to rule out secondary causes B) Z-score -2.2; normal for her age and sport C) T-score -1.2; she has osteopenia and should start treatment with anabolic agent D) T-score - 1.7; she has osteoporosis and should start bisphosphonate Romosozumab-aqqg (Evenity) Romosozumab-aqqg (Evenity) received FDA approval in April 2019. It is a monoclonal antibody that blocks the effects of the protein sclerostin and works mainly by stimulating osteoblastic activity and formation of new bone on trabecular and cortical bone surfaces. By inhibiting sclerostin, romosozumab increases bone mass and bone density and improves the structure of bone and bone strength.
It is an injectable medicine and one dose is two injections that are given sequentially each month. It is limited to use for 12 months due to clinical trials with bone markers and another agent should be started afterwards.The “FRActure study in postmenopausal woMen with OstEoporosis” (FRAME) was a phase 3, randomized, double-blind, placebo-controlled, parallel-group trial to evaluate the safety and effectiveness of romosozumab in postmenopausal women with osteoporosis. One year of treatment with Evenity lowered the risk of a vertebral fracture by 73% compared to placebo (an incidence of 0.5% in romosozumab-treated patients versus 1.8% in placebo-treated patient).
This benefit was maintained over the second year of the trial when Evenity was followed by one year of denosumab (Prolia) compared to placebo followed by denosumab. Another phase 3, multicenter, international, randomized, double-blind “Active-ContRolled FraCture Study in Postmenopausal Women with Osteoporosis at High Risk” (ARCH) was designed to evaluate the superiority of romosozumab over alendronate. The trial enrolled 4,093 ambulatory postmenopausal women and treatment with romosozumab followed by alendronate resulted in a 48% lower risk for vertebral fractures compared with alendronate only.
If you are experiencing symptoms that may be related to emerging treatments and algorithm for fragility fractures, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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