Osteoporosis

ACP Releases Updated Osteoporosis Treatment Guidelines

The American College of Physicians has released an updated guideline for the treatment of osteoporosis and low bone density for the prevention fractures.

The guidelines update the 2008 ACP recommendations, and are based on a systematic review of randomized controlled trials, systematic reviews, large observational studies, and case reports published between 2005 and 2011, updated to 2016 using a machine-learning method.
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Among the recommendations:

  • Pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab should be offered for the reduction of risk of hip and vertebral fractures in women with osteoporosis.
  • Treatment with bisphosphonates should be utilized for the reduction of risk of vertebral fracture in men with clinically recognized osteoporosis.
  • Bone density monitoring should not be done during the 5-year pharmacologic treatment period for women with osteoporosis.
  • Menopausal estrogen therapy should not be used for the treatment of osteoporosis in women.
  • Decision to treat women with osteoporosis who are 65 years of age or older should be based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications.

Future research should focus on the treatment of osteoporosis in men and the efficacy of pharmacological treatments for reducing fractures in patients with osteopenia, according to the authors.

—Michael Potts

Reference:

Qaseem A, Forciea MA, McLean RM, et al. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians [published online May 9, 2017]. Ann Intern Med. doi:10.7326/M15-1361.