Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Ta-Wei Tai¹, Hsuan-Yu Chen², Chien-An Shih¹, Chun-Feng Huang^{3

4

5}, Eugene McCloskey⁶, Joon-Kiong Lee⁷, Swan Sim Yeap⁸, Ching-Lung Cheung⁹, Natthinee Charatcharoenwitthaya¹⁰, Unnop Jaisamrarn¹¹, Vilai Kuptniratsaikul¹², Rong-Sen Yang², Sung-Yen Lin^{13

14

15

16}, Akira Taguchi^{17

18}, Satoshi Mori¹⁹, Julie Li-Yu²⁰, Seng Bin Ang²¹, Ding-Cheng Chan^{22

23}, Wai Sin Chan²⁴, Hou Ng²⁵, Jung-Fu Chen²⁶, Shih-Te Tu²⁷, Hai-Hua Chuang^{28

29

30

31}, Yin-Fan Chang³², Fang-Ping Chen^{33

34}, Keh-Sung Tsai²³, Peter R Ebeling³⁵, Fernando Marin^{36

37}, Francisco Javier Nistal Rodríguez³⁸, Huipeng Shi³⁹, Kyu Ri Hwang⁴⁰, Kwang-Kyoun Kim⁴¹, Yoon-Sok Chung⁴², Ian R Reid⁴³, Manju Chandran⁴⁴, Serge Ferrari⁴⁵, E Michael Lewiecki⁴⁶, Fen Lee Hew⁸, Lan T Ho-Pham⁴⁷, Tuan Van Nguyen^{48

49

50}, Van Hy Nguyen⁵¹, Sarath Lekamwasam⁵², Dipendra Pandey⁵³, Sanjay Bhadada⁵⁴, Chung-Hwan Chen^{13

14

15

55

56

57

58

59

60}, Jawl-Shan Hwang⁶¹, Chih-Hsing Wu^{32

62

63}

Affiliations

¹ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Orthopedic Surgery, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
³ Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.
⁴ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan.
⁶ Division of Clinical Medicine, School of Medicine and Population Health, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, UK.
⁷ Department of Orthopaedics, Beacon Hospital, Petaling Jaya, Selangor, Malaysia.
⁸ Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia.
⁹ Department of Pharmacology and Pharmacy, Centre for Genomic Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
¹⁰ Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Thammasat University, Thailand.
¹¹ Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
¹² Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹³ Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁴ Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁵ Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁶ School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁷ Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Nagano, Japan.
¹⁸ Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, Nagano, Japan.
¹⁹ Bone and Joint Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
²⁰ Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
²¹ Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, Singapore.
²² Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
²³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
²⁴ Department of Internal Medicine Orthopaedics, Centro Hospitalar Conde de Sao Januario, Macao, China.
²⁵ Department of Internal Medicine, Centro Hospitalar Conde de Sao Januario, Macau, China.
²⁶ Division of Metabolism and Endocrinology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
²⁷ Division of Endocrinology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
²⁸ Department of Family Medicine, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
²⁹ Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
³⁰ Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan.
³¹ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³² Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³³ Department of Obstetrics and Gynecology, Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
³⁴ Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
³⁵ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
³⁶ Department of Endocrinology, Hospital Universitario Quironsalud, Madrid, Spain.
³⁷ Medical Sciences School, Universidad Europea, Madrid, Spain.
³⁸ Department Orthopaedic Surgery and Traumatology, Hospital Universitario Rio Hortega, Valladolod, Spain.
³⁹ National Center for Orthopedics, Department of Orthooedics, Shanghai 6th People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴⁰ Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
⁴¹ Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea.
⁴² Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea.
⁴³ Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁴⁴ Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore.
⁴⁵ Service of Bone Diseases, Department of Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
⁴⁶ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
⁴⁷ BioMedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.
⁴⁸ Tâm Anh Research Institute, Ho Chi Minh City, Viet Nam.
⁴⁹ School of Population Health, UNSW Medicine, UNSW Sydney, Australia.
⁵⁰ Centre for Health Technologies, University of Technology Sydney (UTS), Sydney, Australia.
⁵¹ Orthopaedic Center, Hue Central Hospital, Hue City, Viet Nam.
⁵² Department of Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka.
⁵³ Koshi Hospital, Biratnagar, Nepal.
⁵⁴ Department of Endocrinology, PGIMER, Chandigarh, India.
⁵⁵ Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵⁶ Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵⁷ Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵⁸ Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁵⁹ Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan.
⁶⁰ Graduate Institute of Materials Engineering, College of Engineering, National Pingtung University of Science and Technology, Pingtung, Taiwan.
⁶¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
⁶² Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶³ Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

PMID: 38690538
PMCID: PMC11056428
DOI: 10.1016/j.afos.2024.02.001

Review

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Ta-Wei Tai et al. Osteoporos Sarcopenia. 2024 Mar.

. 2024 Mar;10(1):3-10.

doi: 10.1016/j.afos.2024.02.001. Epub 2024 Mar 16.

Authors

Affiliations

¹ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Orthopedic Surgery, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
³ Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.
⁴ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan.
⁶ Division of Clinical Medicine, School of Medicine and Population Health, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, UK.
⁷ Department of Orthopaedics, Beacon Hospital, Petaling Jaya, Selangor, Malaysia.
⁸ Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia.
⁹ Department of Pharmacology and Pharmacy, Centre for Genomic Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
¹⁰ Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Thammasat University, Thailand.
¹¹ Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
¹² Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹³ Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁴ Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁵ Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁶ School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁷ Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Nagano, Japan.
¹⁸ Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, Nagano, Japan.
¹⁹ Bone and Joint Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
²⁰ Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
²¹ Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, Singapore.
²² Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
²³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
²⁴ Department of Internal Medicine Orthopaedics, Centro Hospitalar Conde de Sao Januario, Macao, China.
²⁵ Department of Internal Medicine, Centro Hospitalar Conde de Sao Januario, Macau, China.
²⁶ Division of Metabolism and Endocrinology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
²⁷ Division of Endocrinology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
²⁸ Department of Family Medicine, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
²⁹ Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
³⁰ Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan.
³¹ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³² Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³³ Department of Obstetrics and Gynecology, Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
³⁴ Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
³⁵ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
³⁶ Department of Endocrinology, Hospital Universitario Quironsalud, Madrid, Spain.
³⁷ Medical Sciences School, Universidad Europea, Madrid, Spain.
³⁸ Department Orthopaedic Surgery and Traumatology, Hospital Universitario Rio Hortega, Valladolod, Spain.
³⁹ National Center for Orthopedics, Department of Orthooedics, Shanghai 6th People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴⁰ Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
⁴¹ Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea.
⁴² Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea.
⁴³ Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁴⁴ Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore.
⁴⁵ Service of Bone Diseases, Department of Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
⁴⁶ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
⁴⁷ BioMedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.
⁴⁸ Tâm Anh Research Institute, Ho Chi Minh City, Viet Nam.
⁴⁹ School of Population Health, UNSW Medicine, UNSW Sydney, Australia.
⁵⁰ Centre for Health Technologies, University of Technology Sydney (UTS), Sydney, Australia.
⁵¹ Orthopaedic Center, Hue Central Hospital, Hue City, Viet Nam.
⁵² Department of Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka.
⁵³ Koshi Hospital, Biratnagar, Nepal.
⁵⁴ Department of Endocrinology, PGIMER, Chandigarh, India.
⁵⁵ Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵⁶ Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵⁷ Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵⁸ Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁵⁹ Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan.
⁶⁰ Graduate Institute of Materials Engineering, College of Engineering, National Pingtung University of Science and Technology, Pingtung, Taiwan.
⁶¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
⁶² Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶³ Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

PMID: 38690538
PMCID: PMC11056428
DOI: 10.1016/j.afos.2024.02.001

Abstract

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition. The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach.

Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and antiresorptive agents in sequential therapy approaches.

Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to antiresorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for individuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment.

Conclusions: This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Keywords: Anti-osteoporosis medication; Asia–Pacific; Consensus; Fracture prevention; Sequential therapy.

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Conflict of interest statement

The authors disclosed the following conflicts of interest.1.Ta-Wei Tai received honoraria for lectures, meetings, and/or travel from Amgen and Alvogen/Lotus.2.Swan Sim Yeap has received honoraria for lectures from Amgen.3.Natthinee Charatcharoenwitthaya received honoraria for lectures, meetings, and/or travel from Amgen, Alvogen, and Zuellig Pharma.4.Akira Taguchi has received lecture fees from Asahi Kasei Pharma Corp., Daiichi Sankyo Co. Ltd, Chugai Pharmaceutical Co. Ltd, and Teijin Pharma Ltd.5.Peter R Ebeling has received research funding from Amgen, Alexion and Sanofi, and honoraria from Amgen, Alexion and Kyowa Kirin.6.Fernando Marin has received honoraria for lectures from DKSH and Zuellig Pharma. He is a former employee of Eli Lilly and Company.7.Yoon-Sok Chung has received research funding from Samsung Bioepis and honoraria from Amgen, Alvogen, Celltrion, Daewoong, Hanlim, and Yuyu.8.Ian R Reid has received speaking fees from Amgen and Medison Pharma.9.Manju Chandran has received honoraria and travel sponsorships from Amgen, DKSH, and Kyowa Kirin.10.E. Michael Lewiecki - Amgen: investigator, consultant, speaker; Radius: investigator, consultant; Kyowa Kirin: consultant, speaker; Ultragenyx: investigator; Angitia: consultant; Ascendis: consultant.11.Fen Lee Hew has received honoraria from Amgen and DKSH.12.Tuan Van Nguyen has received a global competitive grant from Amgen and honoraria from Amgen, DKSH, and Bridge Health Care, for giving lectures and travelling to meetings.13.Chung-Hwan Chen received honoraria for lectures, attending meetings, and/or travel from Amgen, and Alvogen/Lotus.14.Chih-Hsing Wu received honoraria for lectures, attending meetings, and/or travel from Eli Lilly, Roche, Amgen, Merck, Servier laboratories, GE Lunar, Harvester, TCM Biotech, and Alvogen/Lotus.15.The other authors reported that they have nothing to declare for potential conflicts of interest.

Figures

**Fig. 1**
Diagram of major concepts of the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis. FLS, fracture liaison service; IV, intravenous; SERMs, selective estrogen receptor modulators; AOM, anti-osteoporosis medication.

See this image and copyright information in PMC

References

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Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Affiliations

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources