An article on osteoporosis care was published in nearly every issue of GORS in 2021. New treatment options for osteoporosis and underlying bone loss are arriving when they are needed most: when demographic trends are creating headwinds exacerbating the limits of care systems. Although powerful new drugs have been shown to increase BMD, other adjunctive options are also emerging, including procedural treatments that might transform how very high fracture risk patients are treated.¹ These new options may immediately impact fracture risk during the early, highest-risk time after an index fragility fracture and prior to the onset of protection of current drugs. Since procedural treatments are more invasive, we should expect the number needed to treat (NNT) to prevent a hip fracture to be lower than what has been reported for drugs in the past. The identification of high-risk patients will be key to establishing a low NNT. Fracture Liaison Services (FLS) are frequently regarded as a critical component of secondary fracture prevention efforts.² In combination with epidemiology-based fracture risk calculation tools such as FRAX or Garvan, FLS are considered state-of-the-art at identifying high-risk patients. They allow for stratification of patients into risk sub-groups, helping clinicians to tailor treatment strategies based on patients’ risk of fracture.³ Orthopedic surgeons will play a leading role in closing the care gap since patients with fragility fractures present daily. They may need optimized tools, however, given that algorithms based on epidemiological data may lack sufficient specificity to be reliable at the individual patient level. For instance, algorithms do not consider recency of fracture or life expectancy, both key to understanding who would benefit most from treatment. Due to these limitations, the NNT to prevent a fracture may remain high, potentially slowing adoption of new treatment options.

中文翻译：

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识别患者的新方法从旨在预防脆性骨折的新治疗方案中获益最多

2021 年，几乎每一期 GORS 都发表了一篇关于骨质疏松症护理的文章。针对骨质疏松症和潜在骨质流失的新治疗方案正在最需要的时候出现：当人口趋势造成不利因素，加剧了护理系统的局限性时。尽管强大的新药已被证明可以增加骨密度，但也出现了其他辅助选择，包括可能改变高骨折风险患者治疗方式的程序性治疗。¹这些新选择可能会在指数脆性骨折后和当前药物开始保护之前的早期、最高风险时间立即影响骨折风险。由于程序性治疗更具侵入性，我们应该预计预防髋部骨折所需的治疗数量 (NNT) 将低于过去报道的药物治疗数量。识别高危患者将是建立低 NNT 的关键。骨折联络服务 (FLS) 通常被认为是继发性骨折预防工作的重要组成部分。²结合 FRAX 或 Garvan 等基于流行病学的骨折风险计算工具，FLS 被认为是识别高危患者的最先进技术。它们允许将患者分层为风险亚组，帮助临床医生根据患者的骨折风险定制治疗策略。³由于每天都有脆性骨折患者出现，骨科医生将在缩小护理差距方面发挥主导作用。然而，他们可能需要优化工具，因为基于流行病学数据的算法可能缺乏足够的特异性，无法在个体患者水平上可靠。例如，算法不考虑骨折的新近程度或预期寿命，这两者都是了解谁将从治疗中受益最多的关键。由于这些限制，防止骨折的 NNT 可能仍然很高，可能会减慢新治疗方案的采用。