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ACP issues guidelines to reduce fracture risk in women with osteoporosis

Today, the ACP released an updated evidence-based clinical practice guideline strongly recommending that physicians treat women with osteoporosis with denosumab or bisphosphonates, such as alendronate, risedronate or zoledronic acid, to reduce fracture risk.

“Osteoporosis is found in an estimated 200 million people worldwide, and an estimated 54 million men and women in the United States have osteoporosis or low bone density,” Amir Qaseem, MD, PhD, MHA, for the Clinical Guidelines Committee of the ACP, and colleagues wrote in the guideline. “Approximately 50% of Americans older than 50 years are at risk for osteoporotic fracture.”

The guideline, published in Annals of Internal Medicine, is based on a systematic review of randomized controlled trials, large observation studies, case reports and other reviews published between Jan. 2, 2005, and June 3, 2011 that compared the benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D and estrogen. The researchers assessed clinical outcomes including fractures and adverse events.

In the guideline, ACP made six essential recommendations for the treatment of men and women with low bone density and osteoporosis. To reduce the risk of hip and vertebral fractures in osteoporotic women, clinicians should offer pharmacologic treatment with alendronate, risedronate, zoledronic acid or denosumab. Women with osteoporosis should be treated with pharmacologic therapy for 5 years and may be continued after the 5 years if considered appropriate or beneficial after the reassessment of the risks and benefits of continuing therapy. Clinicians should offer drug treatment with bisphosphonates for men with osteoporosis to prevent vertebral fracture.

“The evidence specifically for men is sparse,” Jack Ende, MD, MACP, president of ACP, said in a related news release. “However, the data did not suggest that outcomes associated with drug treatment would differ between men and women if based on similar bone mineral density, so treatment for men may be appropriate.”

Bone density monitoring for osteoporosis should not be conducted in women during the 5-year treatment period. Clinicians should not treat osteoporotic women with menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene. Patient preferences and fracture risk profile, as well as the benefits, harms and costs of medications prior to deciding to treat high-risk women aged 65 years or older should be discussed between the clinician and patient.

“Physicians should prescribe generic drugs to treat patients with osteoporosis whenever possible and they should discuss the importance of medication adherence, especially for bisphosphonates,” Ende said in the release.

The guideline is endorsed by the American Academy of Family Physicians. – by Alaina Tedesco

Disclosure: The researchers report funding from the ACP operating budget.