Endocrine Society issues new osteoporosis guidelines

  • Eastell R & al.
  • J Clin Endocrinol Metab
  • 25 Mar 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • The Endocrine Society has released new pharmacological treatment guidelines for osteoporosis in postmenopausal women that recommend bisphosphonates or denosumab (Prolia, Xgeva) as first-line therapies.

Why this matters

  • The United States has seen a decline in the use of bisphosphonates and a plateau or increase in hip fracture after a decade-and-a-half decline.

Key points

  • Postmenopausal women with high fracture risk, especially if the fracture is recent, should be treated with pharmacological therapies because, according to a commissioned meta-analysis of 107 randomized clinical trials, the benefits outweigh the risks.
  • Initial treatment for fracture risk reduction should include the bisphosphonates (alendronate, risedronate, or zoledronic acid) or, alternately, denosumab.
    • Bisphosphonates should be prescribed for 3-5 years before reassessing risk. Women at high risk for fracture should continue treatment, whereas those at low to moderate risk should be considered for a "bisphosphonate holiday" of 2-4 years.
    • Denosumab is an alternative to bisphosphonates for initial treatment, with a recommended dosage of 60 mg subcutaneously every 6 months. Fracture risk should be reassessed after 5-10 years.
  • In postmenopausal women at very high risk for fracture (severe or multiple vertebral fractures), teriparatide or abaloparatide should be prescribed for up to 2 years.
  • Calcium plus vitamin D should be used as an adjunct to pharmacological therapies.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit