Leitlinie Osteoporose 2023 – Differenzialtherapie – welches Medikament für wen?

In recent years, differential therapy for osteoporosis has gained increasing importance, particularly with regard to personalization of treatment. The updated S3 guideline Prophylaxis, Diagnosis and Therapy of Osteoporosis of the German Osteology Association (DVO) from 2023 emphasizes the importance of a differentiated therapy that considers not only antiresorptive but also osteoanabolic treatment approaches in a newly structured three-stage grading of therapy thresholds and with specific recommendations. Based on the measured bone mineral density and individual risk factors, a personal 3‑year fracture risk is calculated based on German health insurance data. Different risk thresholds exist for men and women depending on age. If the fracture risk exceeds 3%, there is an indication for osteospecific therapy. The osteospecific differential therapy should be chosen for each patient individually taking into consideration individual treatment goals, fracture risk, fracture-reducing efficacy, approval status, contraindications, and side effects of individual medications, as well as economic aspects. This allows to optimally balance efficacy, safety, and tolerability. By considering the individual risk profile and fracture risk-specific approach, therapy goals can be achieved more effectively, thereby reducing the risk of osteoporotic fractures. The differential therapeutic approaches of osteoporosis are, thus, an important step towards personalized and effective treatment of this common condition.