Clin Osteol 2026; 31(3): 169-176

Od stratifikace rizik k inovaci léčby osteoporózy u pacientů s vysokým rizikem zlomeninySaid at the congress

MUDr. Zuzana Zafarová

Cílem sympozia společnosti Amgen, které proběhlo 17. 4. 2026 na světovém kongresu o osteoporóze, osteoartróze a muskuloskeletálních onemocněních (WCO-IOF-ESCEO) v Praze, bylo prodiskutovat, jak lze pokrok ve stratifikaci rizik osteoporotických zlomenin přenést do klinické praxe, a zajistit tak časnou systémovou intervenci, která je přínosem zejména u pacientek s velmi vysokým rizikem. Odborníci ze Spojeného království, Austrálie a Dánska se zaměřili na stanovení individuálního rizika osteoporotické zlomeniny, které je východiskem pro volbu léčby vedené k cíli. U žen s velmi vysokým rizikem (nízkotraumatická zlomenina v posledních 2 letech při T-skóre BMD < -2,5 nebo těžká zlomenina obratle nebo více zlomenin nebo zlomeniny či pokles BMD při antiresorpční léčbě) je doporučena anabolická terapie, která je nejúčinnější v 1. linii léčby. Cílem léčby je surogátní parametr snížení rizika osteoporotických zlomenin, a to T-skóre BMD v celkovém proximálním femuru > -2,5, u žen s prodělanou zlomeninou pak > -2,0. Po anabolické léčbě má následovat antiresorpční terapie s cílem zachovat nabytou BMD. Přednášející představili také konkrétní modely koordinované péče (Fracture Liaison Services, FLS) o pacienty s nízkoúrazovými zlomeninami, které dnes nabízejí léčbu s důkazy o účinnosti v prevenci sekundárních osteoporotických zlomenin. Péče v rámci FLS je nákladově efektivní a lze ji provádět v různých modelech podle možností nemocnice. Bylo zjištěno, že diagnostika a léčba osteoporózy vedená ve FLS může snížit nejen riziko následných zlomenin, ale možná i celkovou mortalitu pacientů po prodělané nízkotraumatické zlomenině. Provoz FLS je možné optimalizovat prostřednictvím monitorování klíčových ukazatelů výkonnosti. Sympozium ukázalo cestu, jak se mohou systémy zdravotní péče o jedince s osteoporózou posunout od reaktivního řešení nízkotraumatických fraktur k proaktivní koordinované prevenci.

Published: October 8, 2026  Show citation

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Zafarová Z. Od stratifikace rizik k inovaci léčby osteoporózy u pacientů s vysokým rizikem zlomeniny. Clinical Osteology. 2026;31(3):169-176.
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    References

    1. Balasubramanian A, Zhang J, Chen L, et al. Risk of subsequent fracture after prior fracture among older women. Osteoporos Int. 2019 Jan;30(1):79-92. Go to original source... Go to PubMed...
    2. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001 Jan 17;285(3):320-323. Go to original source... Go to PubMed...
    3. Gehlbach S, Saag KG, Adachi JD, et al. Previous fractures at multiple sites increase the risk for subsequent fractures: the Global Longitudinal Study of Osteoporosis in Women. J Bone Miner Res. 2012 Mar;27(3):645-653. Go to original source... Go to PubMed...
    4. Kanis JA, Cooper C, Rizzoli R, Reginster JY; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019 Jan;30(1):3-44. Go to original source...
    5. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract. 2020 May; 26(Suppl 1):1-46. Go to original source... Go to PubMed...
    6. Eastell R, Rosen CJ, Black DM, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595-1622. Go to original source... Go to PubMed...
    7. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021 Sep 1;28(9):973-997. Go to original source... Go to PubMed...
    8. Ferrari S, Lippuner K, Lamy O, Meier C. 2020 recommendations for osteoporosis treatment according to fracture risk from the Swiss Association against Osteoporosis (SVGO). Swiss Med Wkly. 2020 Sep 29;150:w20352. Go to original source... Go to PubMed...
    9. Aleksova J, Ebeling P. First-line treatment of osteoporosis with osteoanabolic therapy: a new opportunity. Intern Med J. 2025 Aug;55(8):1232-1241. Go to original source... Go to PubMed...
    10. Cosman F, Lewiecki EM, Eastell R, et al. Goal-directed osteoporosis treatment: ASBMR/BHOF task force position statement 2024. J Bone Miner Res. 2024 Sep 26;39(10):1393-1405. Go to original source...
    11. Black DM, Bauer DC, Vittinghoff E, et al; Foundation for the National Institutes of Health Bone Quality Project. Treatment-related changes in bone mineral density as a surrogate biomarker for fracture risk reduction: meta-regression analyses of individual patient data from multiple randomised controlled trials. Lancet Diabetes Endocrinol. 2020 Aug;8(8):672-682. Go to original source... Go to PubMed...
    12. Kendler DL, Marin F, Zerbini CAF, et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018 Jan 20;391(10117):230-240. Go to original source...
    13. Saag KG, Petersen J, Brandi ML, et al. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. N Engl J Med. 2017 Oct 12;377(15):1417-1427. Go to original source... Go to PubMed...
    14. Miller PD, Hattersley G, Riis BJ, et al; ACTIVE Study Investigators. Effect of Abaloparatide vs Placebo on New Vertebral Fractures in Postmenopausal Women With Osteoporosis: A Randomized Clinical Trial. JAMA. 2016 Aug 16;316(7):722-733. Go to original source... Go to PubMed...
    15. Leder BZ, Mitlak B, Hu MY, et al. Effect of Abaloparatide vs Alendronate on Fracture Risk Reduction in Postmenopausal Women With Osteoporosis. J Clin Endocrinol Metab. 2020 Mar 1;105(3):938-43. Go to original source... Go to PubMed...
    16. Cosman F, Nieves JW, Dempster DW. Treatment Sequence Matters: Anabolic and Antiresorptive Therapy for Osteoporosis. J Bone Miner Res. 2017 Feb;32(2):198-202. Go to original source...
    17. Langdahl BL, Libanati C, Crittenden DB, et al. Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy: a randomised, open-label, phase 3 trial. Lancet. 2017 Sep 30;390(10102):1585-1594. Go to original source...
    18. Leder BZ, Tsai JN, Uihlein AV, et al. Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): extension of a randomised controlled trial. Lancet. 2015 Sep 19;386(9999):1147-1155. Go to original source... Go to PubMed...
    19. Cosman F, Kendler DL, Langdahl BL, et al. Romosozumab and antiresorptive treatment: the importance of treatment sequence. Osteoporos Int. 2022 Jun;33(6):1243-1256. Go to original source... Go to PubMed...
    20. Cosman F, Libanati C, Deignan C, et al. Romosozumab Followed by Antiresorptive Treatment Increases the Probability of Achieving Bone Mineral Density Treatment Goals. JBMR Plus. 2021 Oct 6; 5(11):e10546. Go to original source... Go to PubMed...
    21. Cosman F, Huang S, Chines A, Cummings SR. Probability of achieving bone mineral density treatment goals with denosumab treatment in women with osteoporosis. 2022 Annual Meeting of the American Society for Bone and Mineral Research. Austin, Texas, USA. September 09-12, 2022. J Bone Miner Res. 2023;38(S1):S1-S364-FRI-580. Go to original source...
    22. Cosman F, Mitlak B, Wang Y, et al. Probability of Achieving BMD Treatment Targets with Abaloparatide and Teriparatide Over 18 Months and Sequential Abaloparatide vs Placebo Followed by Alendronate Over 3.5 Years. Prezentováno na kongres ASBMR 2022: Abstract LB SAT-895.
    23. Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 2004 Oct;15(10):767-778. Go to original source... Go to PubMed...
    24. Ross BJ, Lee OC, Harris MB, et al. Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures. JB JS Open Access 2021;6:e20.00142 Go to original source... Go to PubMed...
    25. Akesson K, Marsh D, Mitchell PJ, et al; IOF Fracture Working Group. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013 Aug;24(8):2135-2152. Go to original source... Go to PubMed...
    26. Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1):136. Go to original source...
    27. McLellan AR, Wolowacz SE, Zimovetz EA, et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int. 2011 Jul;22(7):2083-2098. Go to original source... Go to PubMed...
    28. van Geel TACM, Bliuc D, Geusens PPM, et al. Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting: A prospective cohort study. PLoS One. 2018 Jun 1;13(6):e0198006. Go to original source... Go to PubMed...
    29. Mäkinen VN, Sølling AS, Harsløf T, Langdahl BL. Implementation of a Modified Fracture Liaison Service at Aarhus University Hospital: A 2-Year Retrospective Cohort Study. Calcif Tissue Int. 2026 Jan 23;117(1):14. Go to original source... Go to PubMed...
    30. Andreasen C, Dahl C, Frihagen F, et al. Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative). Osteoporos Int. 2025 Mar;36(3):501-512. Go to original source... Go to PubMed...
    31. Skjødt MK, Nicolaes J, Smith CD, et al. Fracture Risk in Men and Women With Vertebral Fractures Identified Opportunistically on Routine Computed Tomography Scans and Not Treated for Osteoporosis: An Observational Cohort Study. JBMR Plus. 2023 Mar 15;7(5):e10736. Go to original source... Go to PubMed...
    32. Nicolaes J, Skjødt MK, Raeymaeckers S, et al. Towards Improved Identification of Vertebral Fractures in Routine Computed Tomography (CT) Scans: Development and External Validation of a Machine Learning Algorithm. J Bone Miner Res. 2023 Dec;38(12):1856-1866. Go to original source...
    33. Javaid MK, Sami A, Lems W, et al. A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network. Osteoporos Int. 2020 Jul;31(7):1193-1204. Go to original source... Go to PubMed...

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