ECCEO 9-IOF | ATHENS | GREECE | March 18 - 21, 2009 | Megaron Athens International Conference Centre

Daily News 1

HIGHLIGHTS OF THE MEETING

The 9th ECCEO meeting, here in Athens, is the largest meeting in Europe in the field of osteoporosis and osteoarthritis, with more than 4500 attendees seeking information on the epidemiology, pathogenesis, prevention, and treatment of osteoporosis and osteoarthritis. Over 600 abstracts were submitted addressing all these topics.

The meeting started Wednesday March 18 with the Honorary Lecture of R. Baron on the topic “The future of osteoporosis treatment: a look into new targets and compounds”. Professor Baron reminds us that therapeutic intervention can decrease bone resorption (anti-resorptives) and/or increase bone formation (anabolics). These interventions are however complicated by a coupling between resorption and formation in bone remodelling, leading to decreased bone formation in patients treated with anti-resorptive drugs. However, he also showed that the pharmacological profiles of novel anti-resorptive and bone anabolic therapies currently in various phases of development
suggest that alone, or in combined/sequential treatment, they will allow faster and/or more pronounced gains in bone mineral density and bone architecture in the treatment of osteoporosis.

On Thursday, the first session began with the plenary lecture of Professor Silverman that reminded us that adherence to current therapeutic regimens remains suboptimal and that poor compliance and non persistence were significantly associated with greater likelihood of hip fracture and higher direct medical cost for hip fracture (Pl1). Almost all studies conclude that strategies should be developed to improve both compliance and adherence in order to achieve better therapeutic outcomes in osteoporosis treatment. Improving adherence with osteoporosis therapies could have an important economic value in addition to the clinical value of reduced fractures.

In close relation with the plenary session, the first oral presentation used a Markov microsimulation model, to evaluate the impact of varying adherence to bisphosphonate therapy on health outcomes (i.e. the number of fractures prevented and the quality-adjusted life-year) and on the cost-effectiveness of bisphosphonate therapy compared to no-treatment (OC10). This study showed that non-adherence with osteoporosis medications results not only in worsening health outcomes, but also in a significant change in the cost-effectiveness of treatments. Therefore, adherence-enhancing interventions would be worthwhile, both in clinical and economic terms.

A lot of presentations have been dedicated to screening, diagnosis or assessment of risk factor for osteoporosis. For example, it has been shown, using data from a large population-based survey in Norway, that a lifestyle including non-smoking, physical activity and body mass index from young adulthood to old age has a significant age-related impact on bone mass and thereby fracture risk in both sexes (OC11). Another study has shown that in healthy subjects with late menarchal age, bone mass deficit is already observable a few years before the onset of pubertal maturation (OC12). These results suggest that limited estrogens exposure from pre-puberty to peak bone mass is not the main factor responsible for the increased risk of osteoporosis associated with relatively later menarche in healthy women.

Prediction of fracture is also of the greatest interest, for the management of osteoporosis. In this field, two interesting studies have been presented yesterday. The first one showed, from samples of men and women in the European Prospective Investigation into Cancer (EPIC)- Norfolk, that the power of QUS for prediction of future fractures and calculation of 10-year probability of fractures among the elderly is comparable to that of DXA (OC19). The authors believe that, given the ease and low cost of ultrasound, risk assessment tools (like newly-developed FRAX tool) may include QUS measures in their algorithms. A second cross-sectional study suggests that changes in both trabecular and cortical bone microarchitecture contribute to vertebral fractures in men with idiopathic osteoporosis (OC20). As a matter
of fact, in men, cortical porosity and not cortical width is associated with vertebral fractures. These are important results for future research as this suggests that the cortical deficit is different in men and in women with fragility fractures.

The second lecture from Professor Cooper stressed the fact that although pharmacologic intervention might be efficient, only a minority of hip fracture patients are treated, and the scope for even greater reductions in incidence remains an enticing prospect (Pl2).
During the two plenary sessions of Thursday March 19, many of the oral communications were related to the clinical management of osteoporosis. From a pooled data from two randomized trials, HORIZON Pivotal Fracture Trial and HORIZON Recurrent Fracture Trial (H-RFT), it has been shown that a single annual i.v. infusion of zoledronic acid 5mg was associated with significant risk reductions for clinical fractures (both vertebral and non-vertebral) in osteoporotic postmenopausal women aged over 75 years (OC14). In a two-year prospective study, another study has suggested that balloon kyphoplasty, as an addition to medical treatment, leads to a statistically significant reduction of pain status and improvement of physical function (OC18). Further, balloon kyphoplasty reduces occurrence of new vertebral fractures and prevents a height loss and increase of kyphotic deformity in the long term.

Comparative studies were also been presented yesterday. The first study, presented by Professor Devogelaer, compared teriparatide versus alendronate in patients with glucocorticoid-induced osteoporosis (GIO), over a 36-month period (OC15). He showed that patients treated with teriparatide had greater increases in bone mineral density and fewer new vertebral fractures compared with patients treated with alendronate. There was no significant difference between groups in the number of patients with at least one adverse event. The second study, presented by Professor Roux, evaluated the effect of a single annual i.v. infusion of zoledronic acid compared to daily oral risedronate in different subgroups of glucocorticoid-treated patients. The results of the study suggest that a single annual i.v. of zoledronic acid 5mg significantly increases lumbar spine bone mineral density to a greater extent compared to the daily oral risedronate.

The effect of switching from a therapy to another therapy is not very well researched but of primary interest in clinical practice. In this field, a study, presented yesterday, showed that, in postmenopausal women previously treated with alendronate, denosumab significantly increased BMD and rapidly and significantly reduced sCTX-1 compared with continued alendronate treatment (OC22).

The monitoring of pharmacological treatment is also of interest. It has been shown, in previous ECCEO meetings, that changes in bone mineral density at the level of the hip were associated with changes in the incidence of fractures, in women treated over 3-year with strontium ranelate. This year, Professor Bruyère presented the relationship between change in BMD and vertebral fracture incidence in the last 3 years of an 8-year treatment with strontium ranelate. Interestingly, the increase in total hip BMD observed during the last 3 years of the follow-up was associated with a reduction of the incidence of new vertebral fracture during the same period of time (OC23).

An oral communication of Thursday March 19 was related to osteoarthritis. In this study, the authors showed that baseline level of bone and cartilage turnover markers (s-CTX I, u-CTX II, COMP and YKL-40) was not associated with spinal OA progression after 3 years of follow-up (OC17). However, a short-term (3 months) decrease in COMP was associated with an increased risk of spinal OA progression. However, as acknowledged by the authors, further studies are needed to fully understand these results, and the exact interest of COMP in osteoarthritis.

The first day of the ECCEO meeting has then been a great success due to the high scientific quality of the researches presented either in oral or in poster communications.