Les médecins généralistes (MG) jouent un rôle clé dans le diagnostic et la prise en charge de l’ostéoporose (OP). Une étude transversale récente menée avec des médecins généralistes de 8 pays européens (Belgique, France, Allemagne, Irlande, Pologne, Slovaquie, Suisse, R-U) a révélé un déficit de diagnostic et de traitement de l’ostéoporose chez des femmes d’âge ≥ 70 ans ayant un risque accru de fracture de fragilité 1. La méthodologie de l’étude a été publiée1. Le critère de jugement principal était le déficit de traitement de l’OP chez des patientes ayant un risque accru de fracture de fragilité, défini par : (1) antécédent de fracture à un âge ≥ 50 ans, et/ou (2) probabilité de fracture de hanche et de fracture OP majeure supérieure aux seuils d’intervention FRAX, et/ou (3) T-score≤ −2,5 quel que soit le site. Nous comparons ici les données de la cohorte française à celles des 7 autres pays participants. Au total, 3798 femmes ont été enrôlées de mars à octobre 2018, dont 543 en France, nombre comparable à celui des autres pays (sauf la Suisse, n = 205). Par rapport aux autres pays, les patientes de la cohorte française avaient un âge médian élevé (79,0 contre 76,0 à 78,0 ans pour les 7 autres pays) et étaient, après la Pologne, parmi celles ayant le moins bénéficié d’une ostéodensitométrie (8,3 % et 11,4 %, respectivement). Elles avaient plus souvent consulté leur MG pour un renouvellement d’ordonnance (48 % contre 3,2 à 32,7 %), avaient parmi les plus forts taux d’arthrose (64,1 % contre 23,1 à 62,9 %), de polyarthrite rhumatoïde (5,0 % contre 3,2 à 4,9 %) et d’antécédents parentaux de fracture de hanche (13,8 % contre 7,0 à 13,2 %). Elles avaient le plus faible pourcentage d’antécédent de fracture (27,3 % contre 29,8 à 33,3 %) et, après l’Irlande, de diabète (13,8 % et 16,8 % contre 19,2–40,1 %). 3,1 % recevaient une corticothérapie et 21,1 % avaient un T-score ≤ −2,5 à au moins un site, pourcentages dans la fourchette de ceux des autres pays. Plus des 2/3 (69 %) avaient un risque accru de fracture de fragilité, pourcentage le plus élevé après la Suisse (76,1 %). Parmi ces patientes avec risque accru de fracture, 82 % ne recevaient pas de traitement de l’OP, déficit de traitement le plus élevé après celui observé en Allemagne (91 %) et en Pologne (88 %). Parmi les patientes recevant un traitement de l’OP, plus de la moitié recevaient des bisphosphonates oraux (44/75 [58,7 %]), proportion similaire à celles de la Belgique, de l’Allemagne et de la Slovaquie, inférieure à celles de l’Irlande, de la Pologne et du Royaume-Uni, supérieure à celle de la Suisse. Nos données issues de la médecine générale suggèrent que les femmes de 70 ans et plus en France ont un risque de fracture de fragilité plus élevé que les femmes des autres pays européens mais qu’elles sont moins susceptibles de recevoir un traitement de l’OP que dans certains pays. Parmi les femmes qui ont reçu un traitement de l’OP, plus de la moitié ont reçu des bisphosphonates oraux.

Background Bone tissue represents a large systemic compartment of the human body, with an active metabolism, that controls mineral deposition and removal, and where several factors may play a role. For these reasons, several non-skeletal diseases may influence bone metabolism. It is of a crucial importance to classify these disorders in order to facilitate diagnosis and clinical management. This article reports a taxonomic classification of non-skeletal rare congenital disorders, which have an impact on bone metabolism Methods The International Osteoporosis Foundation (IOF) Skeletal Rare Diseases Working Group (SRD-WG), comprised of basic and clinical scientists, has decided to review the taxonomy of non-skeletal rare disorders that may alter bone physiology. Results The taxonomy of non-skeletal rare congenital disorders which impact bone comprises a total of 6 groups of disorders that may influence the activity of bone cells or the characteristics of bone matrix. Conclusions This paper provides the first comprehensive taxonomy of non-skeletal rare congenital disorders with impact on bone physiology.

This study in 8 countries across Europe found that about 75% of elderly women seen in primary care who were at high risk of osteoporosis-related fractures were not receiving appropriate medication. Lack of osteoporosis diagnosis appeared to be an important contributing factor. Treatment rates in osteoporosis are documented to be low. We wished to assess the osteoporosis treatment gap in women ≥ 70 years in routine primary care across Europe. This cross-sectional observational study in 8 European countries collected data from women 70 years or older visiting their general practitioner. The primary outcome was treatment gap: the proportion who were not receiving any osteoporosis medication among those at increased risk of fragility fracture (using history of fracture, 10-year probability of fracture above country-specific Fracture Risk Assessment Tool [FRAX] thresholds, T-score ≤ − 2.5). Median 10-year probability of fracture (without bone mineral density [BMD]) for the 3798 enrolled patients was 7.2% (hip) and 16.6% (major osteoporotic). Overall, 2077 women (55%) met one or more definitions for increased risk of fragility fracture: 1200 had a prior fracture, 1814 exceeded the FRAX threshold, and 318 had a T-score ≤ − 2.5 (only 944 received a dual-energy x-ray absorptiometry [DXA] scan). In those at increased fracture risk, the median 10-year probability of hip and major osteoporotic fracture was 11.2% and 22.8%, vs 4.1% and 11.5% in those deemed not at risk. An osteoporosis diagnosis was recorded in 804 patients (21.2%); most (79.7%) of these were at increased fracture risk. The treatment gap was 74.6%, varying from 53% in Ireland to 91% in Germany. Patients with an osteoporosis diagnosis were found to have a lower treatment gap than those without a diagnosis, with an absolute reduction of 63%. There is a large treatment gap in women aged ≥ 70 years at increased risk of fragility fracture in routine primary care across Europe. The gap appears to be related to a low rate of osteoporosis diagnosis.

This post-hoc analysis queried whether women experiencing fracture on denosumab indicates inadequate treatment response or whether the risk of subsequent fracture remains low with continuing denosumab. Results showed that denosumab decreases the risk of subsequent fracture and fracture sustained while on denosumab is not necessarily indicative of inadequate treatment response.

Impact microindentation is a novel method for measuring the resistance of cortical bone to indentation in patients. Clinical use of a handheld impact microindentation technique is expanding, highlighting the need to standardize the measurement technique. Here, we describe a detailed standard operation procedure to improve the consistency and comparability of the measurements across centers.

This article reports a taxonomic classification of rare skeletal diseases based on metabolic phenotypes. It was prepared by The Skeletal Rare Diseases Working Group of the International Osteoporosis Foundation (IOF) and includes 116 OMIM phenotypes with 86 affected genes.

The FREEDOM study and its Extension provide long-term information about the effects of denosumab for the treatment of postmenopausal osteoporosis. Treatment for up to 8 years was associated with persistent reduction of bone turnover, continued increases in bone mineral density, low fracture incidence, and a favorable benefit/risk profile.

Odanacatib is a cathepsin K inhibitor investigated for the treatment of postmenopausal osteoporosis. Phase 2 data indicate that 50 mg once weekly inhibits bone resorption and increases bone mineral density, with only a transient decrease in bone formation. We describe the background, design and participant characteristics for the phase 3 registration trial.

Despite the proven predictive ability of bone mineral density, Fracture Risk Assessment Tool (FRAX®), bone turnover markers, and fracture for osteoporotic fracture, their use as targets for treatment of osteoporosis is limited.