Objective: To define, by expert consensus, the criteria for the application of a Treat-to-Target (T2T) strategy in osteoporosis, in Spain, and to assess the adequacy of current treatments for it.
Material and methods: Six Spanish experts in osteoporosis formed the Scientific Committee that led the project and designed the questionnaire used in two Delphi rounds. The 24 items included in the questionnaire assessed the experts wish (W) and prognosis (P) for each item to occur in 5-year time, in a seven-point Likert scale (1=entirely disagree; 7=entirely agree). Second round included items without consensus in the first. Consensus was defined as ≥75% of agreement (57) or disagreement (13) responses.
Results: The first round was completed by 112 out of 165 experts and the second by 106. A total of 59.8% of participants were rheumatologists with a mean of 21.3 years (S.D.: 8.5) of clinical experience.
There was consensus on 70% of items. Consensus was established in the utility of T2T strategy to define therapeutic objectives, optimal follow-up and, therapeutic algorithm (W:96.4%; P:82.1%). Experts agreed on the utility of lack of fractures (W:99.1%; P:97.3%), bone mineral density (BMD) (W:91.1%; P:91.1%) and fracture risk reduction by FRAX (W:75.9%; P:84.0%) as therapeutic objectives. Treatment failure was defined as no BMD gain after 2 (W:81.3%; P:82.1) or 3 years (W:77.7%; P:75.9%), new fracture diagnosis within 2 (W:92.0%; P:92.0) or 3 years (W:90.2%; P:88.4%) or the absence of bone turnover markers (BTM) change after 6 months (W:75.0%; P:93.4%) or 1 year (W:90.6%; P:89.6%) of treatment. Except for strontium ranelate (W:76.4%; P:58.5%), consensus was reached for all available and upcoming novel therapies to achieve a therapeutic target trough T2T strategy application.
Conclusion: A T2T strategy in osteoporosis can be implemented in Spain, since therapeutic objectives, treatment failure and appropriate treatment choice for this strategy have been established.
14 May 2016 - 17 May 2016