- 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.
- 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.