The American College of Physicians has updated its guideline from 2017 for pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults.
Key recommendations include use of bisphosphonates as initial treatment of postmenopausal women and men diagnosed with primary osteoporosis and prescribing of the RANK (receptor activator of nuclear factor-κB) ligand inhibitor, denosumab, as second-line in those with contraindications or previous adverse effects to bisphosphonates.
Whether or not to initiate pharmacologic treatment for osteopenia in women aged 65 years is a decision to be made on a case-by-case basis, the guideline recommends, given uncertainty that it would reduce risk of fractures.
The following slideshow summary for primary care is a topline look at the essential recommendations and rationale for each.
Reference: Quaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, et al. Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: a living clinical guideline from the American College of Physicians. Ann Intern Med. 2023;176:224-238. doi:10.7326/M22-1034