Brief summaries in this slide show highlight the latest ACP drug recommendations for both osteoporosis and low bone density.
Physicians should prescribe generic drugs to treat patients with osteoporosis whenever possible, and they should discuss the importance of medication adherence.-ACP President Jack Ende, MD
#1: Give Bisphosphonates to Women.
To reduce the risk of hip and vertebral fractures in women who have known osteoporosis, offer pharmacologic treatment with a bisphosphonate (alendronate, risedronate, or zoledronic acid) or the biologic denosumab. When prescribing bisphosphonates, discuss with patients the importance of adherence and factors that contribute to poor adherence, such as adverse effects, the inconvenience of taking medications, and the absence of symptoms of underlying disease.
2: Treat Women for 5 Years.
Treat osteoporotic women with pharmacologic therapy for 5 years. For some patients, continuing treatment after 5 years may be beneficial and may be appropriate after the risks and benefits are reassessed. The incidence of new clinical vertebral fractures was decreased in patients treated with alendronate who had preexisting fractures and those with a BMD of â2.5 or less after 5 years of initial therapy.
#3: Avoid Bone Density Monitoring.
Do not use bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. Current evidence does not show any benefit for monitoring during treatment. There was no evidence for BMD monitoring for men.
#4: Provide Bisphosphonates to Men.
Offer pharmacologic treatment with bisphosphonates to reduce the risk of vertebral fracture in men who have clinically recognized osteoporosis. No evidence suggests that men and women with similar BMDs would have different outcomes associated with pharmacologic treatment. In 1 study, zoledronic acid reduced vertebral fractures in osteoporotic men.
#5: Forgo Menopausal Estrogen Therapy.
Do not use menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. Estrogen treatment is associated with serious harms, such as increased risk of cerebrovascular accidents and venous thromboembolism that significantly outweigh the potential benefits.
#6: Make Educated Osteopenia Decisions.
Base decisions on whether to treat osteopenic women age â¥ 65 years at high risk for fracture on a discussion of patient preferences; fracture risk profile; and benefits, harms, and costs of medications. Treatment with risedronate in women with osteopenia near the osteoporosis threshold may reduce their fracture risk. Clinicians can use their own judgment based on risk factors for fracture or on a risk assessment tool, such as FRAX (World Health Organization Fracture Risk Assessment Tool).
American College of Physicians recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women have been updated in a recently released guideline.The new guideline examines the benefits and risks of short- and long-term drug treatments, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen.An estimated 54 million adults in the United States have osteoporosis or low bone density and about half of Americans older than age 50 years are at risk for osteoporotic fracture, according to the American Academy of Family Physicians, which endorsed the guideline.Click on the slides above for brief summaries of the latest recommendations for osteoporosis and low bone density treatment.Â SOURCESTreatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update from the American College of Physicianshttp://annals.org/aim/article/2625385/treatment-low-bone-density-osteoporosis-prevent-fractures-men-women-clinicalÂ AAFP Endorses ACP Guideline on Treating Osteoporosishttp://www.aafp.org/news/health-of-the-public/20170511acposteoguide.html