Bone Abstracts

The fundamental purpose of osteoporosis treatment is to reduce the risk of fracture. There is no validated quantitative marker that monitors risk reduction in the individual patient; available treatments are effective, but reduce fracture incidence only by 20–60%, and it is to be expected, therefore, that fractures will arise during treatment. The aim of treat-to-target strategies is to simplify management and ultimately reduce organ damage and improve clinical outcomes. Such strategies have been widely used in cardiovascular and metabolic medicine; however, the role of a treat-to-target strategy in osteoporosis management remains an area for further research. The IOF and ESCEO have reviewed the most likely surrogate parameters currently available: BMD, BTM, FRAX and bone strength. None of these appears to be ready for use in a treat-to-target strategy. All the targets would be unattainable in many patients, even if targets could be agreed upon and validated. Additionally, applying a treat-to-target strategy in individual patients becomes problematic because of the small treatment-induced changes in the candidate parameters. The inability to extrapolate from statistically significant correlations in large clinical trials to make treatment decisions in individual patients, further limits the applicability of this concept in daily clinical practice. Research into the most effective goal-directed treatment of osteoporosis needs to be actively undertaken, and comprises the subject of working groups of the IOF.