Clin Osteol 2026; 31(3): 167-168
Management of patients at very high fracture risk: a revolutionary shift in osteology and new clinical strategiesSaid at the congress
This article summarizes key insights presented by Professor Michael McClung at the World Congress on Osteoporosis (WCO-IOF-ESCEO 2026) regarding the management of patients at very high risk of fracture. The work reflects a revolutionary shift in treatment strategy, wherein osteoanabolic therapies (teriparatide, romosozumab) are becoming first-line treatments aimed at rapidly restoring bone microarchitecture and increasing bone mineral density (BMD). The text introduces the concept of a "bone attack," likening a new fracture to a myocardial infarction and necessitating urgent therapeutic intervention. Furthermore, emphasis is placed on the correct treatment sequence to avoid the so-called "blunting effect" and on the necessity of sequential therapy—following anabolic induction with antiresorptive treatment (denosumab or bisphosphonates)—to stabilize the results achieved and ensure long-term skeletal protection.
Keywords: osteoporosis, very high fracture risk, bone attack, osteoanabolic therapy, sequential therapy, bisphosphonates, denosumab, bone mineral density (BMD)
Published: October 8, 2026 Show citation