Evening Symposium: Treat to Target

Monitoring Effectiveness of Treat-to-Target Osteoporosis Interventions

Thursday, April 20, 2017

  7:30 pm – 9:30 pm

Program  Overview: “Treat-to-target”, or “goal-directed treatments” are concepts used in designing therapeutic strategies with treatment modalities oriented towards achieving a well-defined, clinically relevant end-target. It is a concept already firmly in clinical practice for diseases such as arterial hypertension (blood pressure), coronary heart disease (LDL-C) and diabetes (glucose/HbA1c). For osteoporosis treatments, a natural candidate target of treatment would be bone density but other candidates exist such as bone turnover marker, FRAX score, and fracture itself. However, many of the initial and popular treatments for osteoporosis are not potent enough to move bone density and bone fragility from a high risk profile to one of low risk. New osteoporosis treatments are becoming available that are potent enough to increase bone density to target values. Thus, osteoporosis treat to target strategies are a new and novel paradigm to clinicians.

Osteoporosis treat to target strategies will require further education of clinicians for several reasons. First, treatments such as monoclonal antibodies (denosumab) have an ability to linearly increase BMD without a well-defined or observed plateau value. Earlier treatments, such as bisphosphonates tend to have a maximum effect on BMD that would not guarantee their ability to hit a target. Secondly, there is growing evidence that these dramatic increases in bone density have a proportional decrease in fracture risk. For these two reasons, BMD may be a suitable target for osteoporosis treatments using potent drugs capable of reaching a BMD that substantially decreases fracture risk. Third, when patients come off treatments like denosumab, there is evidence that the gains in the target measure (BMD) can be completely reversed and lost in less than a year. With current monitoring guidelines being repeat BMD measure every two years, there is a need to monitor differently with treat to target modalities. Lastly, other drugs are likely potent enough to use in a treat to target paradigm including abaloparatide, anti-sclerostin therapies, romosozumab, blosozumab, and more.

In short, treat to target is a new concept for osteoporosis and requires advanced knowledge of clinicians involved in the measuring of BMD and monitoring treatment effects.

Educational Objectives:  At the end of this evening program, the audience should be able to:

  • Define the general concept of treat to target and how it could be used in osteoporosis management.
  • Explain the qualities needed in osteoporosis treatments that make the treatment a candidate for treat to target monitoring
  • Describe the evidence on how specific candidate treatments impact BMD and fracture risk and contrast this to other approved osteoporosis treatments.
  • Describe the how monitoring BMD is different when treating osteoporosis to a target versus monitoring non-targeted treatments.
  • List the special concerns regarding drug holidays and cessation of potent treat to target therapies.

Agenda

Start Time Talk Time End Time Title Speaker
7:30 PM 5 min. 7:35 PM Introduction John Shepherd
7:35 PM 20 min. 7:55 PM Benefits and limitations of treating to targets Steve Cummings
7:55 PM 20 min. 8:15 PM Using BMD to monitor treat to target effectiveness Mike Lewiecki
8:15 PM 20 min. 8:35 PM Using bone turnovers to monitor therapy in goal directed world John Schousboe
8:35 PM 20 min. 8:55 PM Safety Monitoring Ken Saag
8:55 PM 35 min. 9:30 PM Panel Discussion Felicia Cosman, Moderator

Accreditation Information

For Physicians:  The International Society for Clinical Densitometry is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The International Society for Clinical Densitometry designates this live educational activity for a maximum of 2.0 AMA PRA Category 1 Credits(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

For Nurses and Nurse Practitioners:  The National Osteoporosis Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.  The National Osteoporosis Foundation designates this session for a maximum of 2.0 continuing nursing education contact hours including 1.5 hours of pharmacology.

For Physician Assistants: This program has been reviewed and is approved for a maximum of 2.0 hours of AAPA Category 1 CME credit by the Physician Assistant Review Panel.  The American Academy of Physician Assistants (AAPA) also accepts educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the Accreditation Council for Continuing Education (ACCME).  Physician assistants may receive a maximum of 2.0 hours of Category 1 credit for completing this session.

Support for this session has been provided by Amgen and Radius.