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With the aid of a new fracture risk model, the great treatment gap for osteoporosis should be closed. All patients older than 70 years should undergo a diagnostic procedure for osteoporosis. An additional risk threshold (≥ 10% per 3 years for femoral and vertebral fractures) should enable patients with a high risk of fracture to be treated with osteoanabolic agents. The use of osteoanabolic agents makes it necessary to administer antiresorptive drugs afterwards. Due to the low event rate of osteonecrosis of the jaw, the initiation of a specific osteoporosis treatment should not be delayed by prophylactic dental treatment. The adherence to the drug treatment should be improved by an individualized approach on the basis of a cooperation between patients, caregivers, and physicians. A regular assessment of falls, including the timed up and go test should be carried out in patients older than 70 years., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In September 2023, the guideline on the prophylaxis, diagnosis, and treatment of osteoporosis in postmenopausal women and men was published as a completely revised guideline. The implications for practice include a change in the justifying indication for performing a bone density measurement, the time interval over which the fracture risk is determined, the level and number of therapy thresholds, and the recommendations for the therapeutic approach that are adapted to the individual fracture risk present. Risk assessment for the prediction of spine and hip fractures is essential in the context of osteoporosis diagnostics. In addition to age and gender, there are a total of 33 risk factors to determine the individual risk of fracture. Much more attention is paid to the assessment of the risk of falls and, depending on the result, combined with recommendations for muscle training and protein intake from the age of 65. Risk indicators must also be taken into account when determining the indication for osteoporosis diagnosis, as well as the risk factors of the imminent risk of fracture. The indication for baseline diagnostics has changed from the >20% 10-year fracture risk to diagnostics in postmenopausal women and in men aged 50 years and older, depending on the fracture risk factor profile. This eliminates a specific fracture risk threshold for basic diagnostics. Thus, in the young patient group (50-60 years), the risk factors considered medically relevant for the indication for osteoporosis diagnosis must be taken into account. New thresholds as an indication for initiating therapy is the determination of fracture risk using a risk calculator over 3 years instead of 10 years. The indication for drug therapy should be based on the threshold values of the DVO risk model. The data clearly suggests a significantly faster and more effective fracture risk-reducing effect of anabolic therapy. This is recommended in the first sequence in cases of a very high risk of fracture from 10%/3 years with osteoanabolic active substances (teriparatide or romosozumab). Such a therapy sequence should be initiated directly and not delayed due to upcoming dental procedures. Follow-up therapy to consolidate the reduction of fracture risk should be chosen individually., Competing Interests: Dr. Friederike Thomasius gibt folgende Interessenskonflikte an: Koordinatorin der Leitlinienkommission des DVO. Prof. Dr. Heide Siggelkow gibt folgende Interessenkonflikte an: Mitglied der Leitlinienkommission des DVO., (Thieme. All rights reserved.)

With the aid of a new fracture risk model, the great treatment gap for osteoporosis should be closed. All patients older than 70 years should undergo a diagnostic procedure for osteoporosis. An additional risk threshold (≥ 10% per 3 years for femoral and vertebral fractures) should enable patients with a high risk of fracture to be treated with osteoanabolic agents. The use of osteoanabolic agents makes it necessary to administer antiresorptive drugs afterwards. Due to the low event rate of osteonecrosis of the jaw, the initiation of a specific osteoporosis treatment should not be delayed by prophylactic dental treatment. The adherence to the drug treatment should be improved by an individualized approach on the basis of a cooperation between patients, caregivers, and physicians. A regular assessment of falls, including the timed up and go test should be carried out in patients older than 70 years., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Since 2018, the present S3 guideline Prophylaxis, Diagnosis and Therapy of Osteoporosis (AWMF 183-001) has been updated following a previous update of the underlying PICO questions (Population-Intervention-Comparison-Outcome questions) for a systematic literature search. The focus of the guideline update, in addition to updating the evidence supporting literature along with recommendations, was the development of a risk calculator for vertebral fractures and femoral neck fractures. This is essential for managing risk assessment because of the multitude of risk factors that contribute to fracture risk. This article considers the development of the guideline update methodologically and substantively, the latter by reflecting on the core themes of the guideline update., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Fracture risk cannot be determined by bone density alone. It is important to identify and consider risk factors that individually increase the risk of fractures when they occur. Risk calculators have been developed worldwide to determine fracture risk. The risk factors currently listed in the Dachverbands Osteologie (DVO) S3 Guidelines for the "Diagnosis and Therapy of Postmenopausal Osteoporosis and Male Osteoporosis" are diverse and should be prioritized, since not every fracture risk factor present increases the risk of a vertebral or femoral neck fracture to the same extent. Due to the unknown interaction between risk factors, no more than two risk factors in addition to age, gender, and bone density measurement should be considered per patient. For risk assessment, it is important that the two thresholds defined by the German guideline are reached, above which diagnostic workup or specific therapy for fracture risk reduction should be recommended. These thresholds are currently defined as 20% for diagnostics and 30% for therapy, based on the absolute 10-year risk for vertebral and femoral neck fractures. The threshold for diagnostics is reached with the presence of a risk factor mentioned in the guideline. To reach the threshold for therapy, the bone density measurement result is required to reach the age-specific T‑score. However, typical fragile fractures of the vertebral bodies or femur increase the fracture risk so substantially that therapy can be recommended even without a bone density result.

Update on fracture prevention after menopause Abstract. Osteoporosis is a common disease. It is multifactorial and polygenetic in pathogenesis as well as clinically underdiagnosed and undertreated. There are several medical specialties involved in the care of female osteoporosis patients. "Gate keepers" of all female osteoporosis patients are the gynecologists, because they see the patient at the onset of menopausal symptoms, which may be indicative of accelerated bone loss. It is important to plan therapy with different sequences, one of which may be gynecologically recommended hormone therapy. Since osteoporosis is a chronic disease in the vast majority of cases, long-term therapy and patient retention is essential.

Since the observations of Fuller Albright in 1940, it is well documented that estrogen deficiency is one of the major causes of osteoporosis. Osteoporosis increases not only the risk of fracture and consecutively the number of fractures but can also induce a disorder of fracture healing. This raises the question whether estrogen deficiency negatively influences bone healing in addition to fragility. The currently available literature on this topic provides indications that estrogen deficiency negatively influences fracture healing in the various stages of healing. Furthermore, there is evidence that the administration of estrogen antagonizes these negative effects. Future clinical investigations are needed to find out whether the experimental data can be transferred to the patients.