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IOF Regional 7th Asia-Pacific Osteoporosis Conference Sydney, Australia 2018 – Sponsored Symposia Abstracts SY1 UNDERSTANDING MORALITY RISK FOR PATIENTS WITH VCF K. L. Ong Exponent Inc., Philadelphia, United States, 2 School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, USA Were vertebral compression fracture (VCF) patients at higher risk of mortality following the 2009 publication of the vertebroplasty “sham” trials? – Osteoporosis Int 2017 Vertebral compression fractures are the most common osteoporotic fractures. The onset of a VCF can lead to a downward spiral of morbidity including mortality. Treatment options for a VCF patient include nonsurgical management, such as back braces and opioids. Alternatively, surgical interventions include vertebroplasty (VP) or balloon kyphoplasty (BKP). This presentation will discuss the differences in mortality risks for VCF patients who undergo non-surgical management, VP, and BKP. The presentation will further describe the treatment pattern changes and associated mortality risks after 2009, when controversy was raised over the VP versus sham trials. SY2 ACHIEVING THE GOALS OF OSTEOPOROSIS THERAPY S. Ferrari Service of Bone Diseases, Geneva University Hospital, Geneva, Switzerland There are two main goals of osteoporosis therapy. First an early and sustained reduction of fracture risk, particularly in patients at imminent risk. Second a long-term improvement of bone mass and structure so that treatment can eventually be interrupted once subjects have achieved a level of bone strength capable to definitely sustain a fall with a minimal risk of fracture. Although all osteoporosis drugs reduce vertebral fracture risk significantly within one year, evidence for clinical and particularly non-vertebral fracture reduction early in the course of therapy is still limited. Zoledronate post-hip fracture reduces clinical fracture by 32% within 2– 3 yrs., whereas denosumab reduces hip fractures 48–62% within 3 years in high risk patients. A recent study comparing TPT and risedronate in patients with prevalent vertebral fractures, 30% of which were recent, provides new evidence that a bone forming agent could be used first in patients at high fracture risk. An observational study in Medicare subjects aged 65+ also indicates that osteoporosis drugs reduce fracture rate early in the course of therapy (i.e. within 15 months), but more so with denosumab and teriparatide. Regarding the long-term benefits on bone mass, bisphosphonates achieve limited gains in hip BMDwithin 3 yrs, whereas denosumab has provided continuous gains for up to ten years, with further reductions in nonvertebral fracture rates from year 4 and a benefits/risk ratio (i.e. number of fractures avoided / skeletal adverse events of ONJ and AFF) > 100 long-term. Interrupting therapy on another side has proven deleterious with all drugs in patients remaining at high risk, such as those with vertebral fractures and/ or not achieving a hip BMD at least > -2.5 (ideally >-2), and with denosumab in particular because of the transient rebound in bone turnover. In this case, the rate of vertebral fractures rapidly increases back to untreated levels, with a slightly higher rate (+1%) of multiple vertebral fractures. Patients in whom discontinuation of denosumab is considered, transition to other therapies must be considered. to consolidate the bone mass gained on that therapy. SY3 THE IMPORTANCE OF BONE FORMING AGENTS IN THE TREATMENT OF SEVERE OSTEOPOROSIS E. Seeman, S. Ferrari Department of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia, Department of Medicine, HCUGUniversity Hospital, Geneva, Switzerland Bone remodelling maintains bone’s material and structural strength until menopause whenremodeling becomes unbalanced and rapid. Less bone is deposited than resorbed during each of the many more remodeling events causing a reduction in total bone matrix volume, microstructural deterioration and bone fragility. Antiresorptives slow unbalanced remodelling, they do not abolish it and so they do not reverse or abolish worsening of microstructural deterioration. The less often remodeled matrix continues to deteriorate albeit more slowly and becomes more glycated, mineralized and so, more brittle. The relative risk for vertebral and hip fractures is reduced by ~50%, but by only 20-30% for non-vertebral fractures. The challenge is to restore bone matrix volume, microstructure, material composition and strength. Teriparatide produce mainly remodelling-based net bone formation by acting on cells of existing remodelling units and by initiating new remodeling events. There is a transitory phase of increased numbers of resorption sites as treatment stimulates RANKL production by osteoblast precursors and osteocytes. Existing and newly generated remodeling events excavate older more mineralized and glycosylated bone upon trabecular, endocortical and intracortical surfaces. These cavities refill or overfill with younger matrix, producing increased numbers of new osteons with their cement lines, lamellae, and osteocytic network. Vertebral and nonvertebral fracture risk is reduced. Studies are needed to evaluate anti-hip fracture efficacy. Recent studies demonstrate that teriparatide has better antifracture efficacy than the bisphosphonate, risedronate. Kendleret al. (2018) compared anti-fracture efficacy of 20 μg of teriparatide once daily versus 35mg oforal risedronate in postmenopausal women with severe osteoporosis in a double-blind trial (VERO). During 24 months new vertebral fractures occurred in 28/680 (5·4%) of patients Osteoporosis International https://doi.org/10.1007/s00198-018-04813-7