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Revised AACE/ACE guideline urges evaluation, treatment for postmenopausal osteoporosis
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All postmenopausal women aged at least 50 years should undergo an evaluation for osteoporosis risk, with therapy recommendations made based on the severity of osteoporosis and fracture risk, according to an updated clinical practice guideline released by the American Association of Clinical Endocrinologists and the American College of Endocrinology.
The guideline task force also released an updated postmenopausal osteoporosis treatment algorithm, presented as an illustrated treatment pathway companion to the guideline. Both documents appear in the September issue of Endocrine Practice.
The last AACE guideline on postmenopausal osteoporosis management was published in 2010; the most recent clinician's guide for postmenopausal osteoporosis from the National Osteoporosis Foundation was published in 2014.
“Many new developments have occurred since then,” Pauline M. Camacho, MD, FACE, AACE president, co-chair of the AACE Osteoporosis Task Force and Endocrine Today Editorial Board member, told Endocrine Today. “Clinicians need guidance on the long-term treatment of osteoporosis. The current guidelines are practical and have recommendations on the duration of bisphosphonate therapy.”
The guideline, Camacho said, incorporates the latest evidence and expert opinion to offer physicians and regulatory bodies needed information to reduce the risk for osteoporosis-related fractures.
Key recommendations include the following:
- All postmenopausal women aged at least 50 years should undergo clinical assessment for osteoporosis and fracture risk, including a detailed history and physical examination using tools such as the WHO clinical fracture risk assessment tool (FRAX), when available.
- Bone mineral density testing is recommended for women aged at least 65 years, as well as younger postmenopausal women at increased risk for bone loss and fracture, based on fracture risk analysis.
- Because of the high prevalence of secondary osteoporosis, medical evaluation is indicated in all women with postmenopausal osteoporosis at high fracture risk to identify coexisting medical conditions that may be causing or contributing to bone loss.
- Patients with lower or moderate fracture risk can be started on oral agents; injectable agents can be considered as initial therapy for those who have the highest fracture risk. AACE does not recommend the use of combination therapy for osteoporosis prevention or treatment.
The task force also recommended effective risk communication with patients to allow better shared decision making regarding any osteoporosis treatment.
“In addition to understanding the potential risk and expected benefits of osteoporosis treatments, patients must fully appreciate the risk of fractures and their consequences (eg, pain, disability, loss of independence and death) when no treatment is given,” the researchers wrote.
The guideline also addresses the concern surrounding prolonged use of bisphosphonates and rare adverse events, such as osteonecrosis of the jaw and atypical femoral fractures, Camacho said in a press release.
“The guidelines will have recommendations on the duration of therapy based on severity of osteoporosis and fracture risk,” Camacho said. “We hope these recommendations will guide clinicians in the long-term care of osteoporosis patients.”
Steven Petak MD, JD, MACE, FACP, associate clinical professor at Weill-Cornell Medical College and division head and chief of endocrinology at Houston Methodist Hospital, said he hoped the guideline and algorithm have a significant impact on practice.
“Osteoporosis is not often a key discussion item in the physician-patient visit and having this guideline and the new treatment algorithm will help make the identification, evaluation and therapy considerations much simpler,” Petak told Endocrine Today. “In addressing many of the controversies in the field, it is hoped that decision making will become more routine in the typical patient visit. Most important, these guidelines need to be used throughout the medical field. Family practice physicians, internists, gynecologists, orthopedic surgeons, neurologists, geriatricians, physical medicine and rehabilitation physicians, rheumatologists and other medical subspecialists all need to become familiar with how to help their patients reduce their risks for fracture.” – by Regina Schaffer
For more information:
Pauline M. Camacho, MD, FACE, can be reached at the Division of Endocrinology and Metabolism, Loyola University Medical Center, 2160 S. First Ave., Fahey Center, Suite 137, Maywood, IL 60153; email: PCAMACH@lumc.edu.
Disclosure: Camacho reports receiving research grant support from Amgen Inc. and NPS Pharmaceuticals. Please see the full clinical practice guideline for the other authors’ relevant financial disclosures.
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