New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
Endocrinol Metab (Seoul). 2021 Apr;36(2):270-278. doi: 10.3803/EnM.2021.970. Epub 2021 Mar 24.
Treat-to-target (TTT) for osteoporosis is a concept for individualizing patient treatment decisions that focuses on achieving an acceptable level of fracture risk rather than response to treatment alone. While a response to treatment is essential in order to achieve an acceptable level of risk, it is not necessarily sufficient. Some patients have a good response to treatment yet remain at high level of fracture risk. Since there is no way to directly measure bone strength in patients treated for osteoporosis, a surrogate measurement must be used. Bone mineral density (BMD) is commonly used to select patients for treatment and has emerged as the most useful surrogate for assessing reduction of fracture risk after treatment is started. Recent large meta-regression studies have shown a robust correlation between larger increases in BMD with treatment and greater reductions in fracture risk. Application of TTT for osteoporosis involves assessing fracture risk before starting treatment and initiating treatment with an agent that is most likely to reduce fracture risk to an acceptable level, represented by a target BMD T-score, over a reasonable period of time. This review offers suggestions for implementing TTT for osteoporosis in clinical practice and managing patients who fail or succeed in reaching the target. More study is needed to fully validate the use of TTT for osteoporosis for initiating and modifying treatments to reduce fracture risk.
骨质疏松症的达标治疗（Treat-to-target，TTT）是一种个体化患者治疗决策的概念，其重点在于实现可接受的骨折风险水平，而不仅仅是关注治疗反应。虽然为了达到可接受的风险水平，治疗反应是必不可少的，但它并不一定足够。一些患者对治疗有很好的反应，但仍处于高骨折风险水平。由于无法直接测量接受骨质疏松症治疗的患者的骨强度，因此必须使用替代测量方法。骨密度（bone mineral density，BMD）常用于选择治疗患者，并且已成为评估治疗开始后骨折风险降低的最有用替代指标。最近的大型荟萃回归研究表明，治疗后 BMD 增加与骨折风险降低之间存在很强的相关性。骨质疏松症 TTT 的应用包括在开始治疗之前评估骨折风险，并在合理的时间内使用最有可能将骨折风险降低到可接受水平的药物进行治疗，该水平以目标 BMD T 评分表示。这篇综述为在临床实践中实施骨质疏松症 TTT 以及管理达到或未达到目标的患者提供了建议。需要进一步的研究来充分验证 TTT 在启动和调整治疗以降低骨折风险方面对骨质疏松症的应用。
