Is a treat-to-target strategy in osteoporosis applicable in clinical practice? Consensus among a panel of European experts

Research output: Contribution to journalResearch articleContributedpeer-review


  • T Thomas - , Hôpital Nord, CHU de Saint-Étienne, Université Lumière Lyon 2 (Author)
  • E Casado - , Parc Taulí Research and Innovation Institute (Author)
  • P Geusens - , Maastricht University (Author)
  • W F Lems - , University of Amsterdam (Author)
  • J Timoshanko - , UCB S.A. (Author)
  • D Taylor - , Ogilvy Health (Author)
  • L C Hofbauer - , University Hospital Carl Gustav Carus Dresden (Author)


A panel of European experts was convened to establish consensus on a treat-to-target strategy in osteoporosis. Panellists agreed that the ultimate goals of treating osteoporosis are recovering pre-fracture functional level and reducing subsequent fracture risk; there was consensus that total hip bone mineral density is currently the most appropriate treatment target in clinical practice.

INTRODUCTION: A modified Delphi approach was convened to establish consensus among European experts on best practice management for patients with fragility fractures and whether a treat-to-target (T2T) strategy is applicable in osteoporosis.

METHODS: A panel of 12 clinical experts (from eight European countries) voted on 13 final statements relating to a T2T strategy for osteoporosis across three rounds of blinded, remotely conducted electronic surveys (Likert scale: 'strongly disagree', 'disagree', 'unable to answer', 'agree', 'strongly agree'). When panellists disagreed, they were asked how the statement could be adjusted to allow for a positive response, which was used to refine the statement for the following round. Consensus was defined as ≥ 75% agreement with a statement. Panellists were selected by UCB Pharma, which provided financial and logistical support.

RESULTS: Consensus was reached for 13/13 statements. Panellists agreed that the most important goals for fragility fracture patients are recovery of pre-fracture functional level and reduction of subsequent fracture risk. There was also consensus that a T2T strategy is applicable to osteoporosis and that bone mineral density (BMD) is currently the most clinically appropriate target. With regard to the definition of a specific BMD treatment target and timeframes applicable to T2T in osteoporosis, no clear consensus was reached; panellists emphasised that these would need to be individually determined.

CONCLUSIONS: According to a panel of European experts, the main goals of fracture management are to recover pre-fracture functional level and reduce fracture risk. Total hip BMD seems to be the most clinically appropriate treatment target within a T2T strategy.


Original languageEnglish
Pages (from-to)2303-2311
Number of pages9
Journal Osteoporosis international
Issue number12
Publication statusPublished - Dec 2020
Externally publishedYes

External IDs

PubMedCentral PMC7661407
Scopus 85089186850
ORCID /0000-0002-8691-8423/work/142236050



  • Bone Density, Consensus, Europe, Fractures, Bone, Humans, Osteoporosis/drug therapy