Here: a quick overview of updates to the diagnosis and treatment of osteoporosis.
New diagnostic guidelines; update on current therapies; new bisphosphonate strategies: a quick overview follows. ©Filipchuk oleg / Shutterstock.com
New ACP guidelines have improved the specificity of criteria for diagnosis of osteoporosis.1,2 The current standard of low BMD (femoral neck BMD of ≥2.5 SD below the young female adult mean) is recognized as an “imperfect” predictor of fracture risk, with < 50% accuracy, and the presence of fragility fractures has been added to diagnostic criteria. The guidelines also expanded the target population of patients from post-menopausal women to include premenopausal women and men with clinical signs of osteoporosis.
The mechanism of most established treatments is to prevent bone loss by reducing resorption. Calcitonin has declined in use for osteoporosis, although it is still available. Etidronate and pamidronate were removed from the guidelines, as neither has FDA-approval for the prevention of fractures or treatment of osteoporosis. Bazedoxifene, a SERM, was recently approved for use with conjugated estrogen for the prevention of osteoporosis. The guidelines note that calcium and vitamin D may be added as dietary supplements to osteoporosis treatment regimens, but their effectiveness on fracture prevention is unclear. ©Patricia Chumillas/ Shutterstock.com
High quality evidence showed that, compared to placebo, treatment with bisphosphonates (including alendronate, risidronate, and zoledronic acid) reduced vertebral, nonvertebral, and hip fractures in postmenopausal osteoporotic women.
Sub-Q abaloparatide (80 µg/day) (ABL) for 18 mo followed by alendronate PO for 6 mo (70 mg/week) (ALN) produced greater gains in BMD and fewer vertebral and non-vertebral fractures compared to 6 mo of ALN alone.
New ACP guidelines improve the specificity of criteria for diagnosis of osteoporosis; update standard therapies; and update bisphosphonate treatments. A brief overview follows.
1. Qaseem A, Forciea MA, McLean RM, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. 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. Ann Intern Med. 2017;166:818-839. 2. Qaseem A, Snow V, Shekelle P, et al. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008;149:404-415.3. Paci M, Burks S, Wang MS. Consensus Guidelines for the Treatment of Osteoporosis. Neurosurgery. 2018;82:N6âN7.4. Reginster JY, Al Daghri N, Kaufman JM, BruyÃ¨re O. Effect of a sequential treatment combining abaloparatide and alendronate for the management of postmenopausal osteoporosis. Expert Opin Pharmacother 2017 Dec 22:1-3. doi: 10.1080/14656566.2017.1418857. 5. Eiken P, Vestergaard P. Treatment of osteoporosis after alendronate or risedronate. Osteoporos Int. 2016;27:1-12.