Research Needed to Improve Osteoporotic Drug Therapy: Takeaways From NIH Pathways to Prevention Workshop

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Experts at the NIH's Pathways to Prevention Workshop identified areas of research needed to advance long-term osteoporotic drug therapy.

Experts at the National Institutes of Health (NIH)’s Pathways to Prevention Workshop identified areas of research needed to advance long-term osteoporotic drug therapy, according to an article published in the Annals of Internal Medicine.

These areas include innovative designs/approaches in research, interventions without adverse effects, and barriers to osteoporotic drug therapy.

The workshop, which was cosponsored by the NIH Office of Disease Prevention, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and National Institute on Aging, used an independent panel to assess current available evidence regarding long-term use (>3 years) of drug therapies to prevent osteoporotic fractures. The panel also identified research gaps and needs for advancing the field.

The panel identified the following areas as targets for future research to advance the treatment of osteoporotic drug therapy:

  • Researchers should use innovative designs and approaches to assess existing and potential treatments and optimizing duration, including the use of comparative effectiveness study designs and fracture sequelae outcomes.
  • New clinical trials are needed to identify new or multicomponent interventions that have fewer adverse effects than current antiresorptive treatments and greater efficacy.
  • Because of the rare but serious adverse events associated with long-term bisphosphonate or denosumab use, researchers need to identify ways to prevent and characterize atypical femoral fractures and osteonecrosis of the jaw.
  • More research must be done to determine optimal patient candidates for drug holidays and sequential therapies.
  • More strategies should be developed to decrease the likelihood of serious adverse events related to long-term bisphosphonate or denosumab use.
  • The panel recommends more research on barriers to osteoporotic drug therapy. This includes empirical studies on the efficacy of different management approaches, studies that determine which patients initiate treatment, studies that identify ways to improve adherence to long-term osteoporotic drug therapies, and research that determines the best context for shared decision making.

“The research outlined above is urgently needed to advance prevention of osteoporosis-related mortality and morbidity,” the panel members wrote.

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Siu A, Allore H, Brown D, Charles ST, Lohman M. National Institutes of Health Pathways to Prevention Workshop: research gaps for long-term drug therapies for osteoporotic fracture prevention [published online April 23, 2019]. Ann Intern Med. doi:10.7326/M19-0961