The Endocrine Society has published new clinical practice guidelines on the pharmacological management of osteoporosis in post-menopausal women.
Among the key recommendations are:
- Bisphosphonates are recommended as the first-line therapeutic choice for post-menopausal women at high risk of fracture.
- Fracture risk should be re-assessed after an individual has been on bisphosphonates for three-five years.
- Following re-assessment, women who are on bisphosphonates and are at low-to-moderate risk of fracture should be prescribed a 'bisphosphonate holiday' for up to five years.
- Denosumab at a dose of 60 mg subcutaneously every six months is recommended as an alternative initial treatment for those at high risk of osteoporotic fractures.
- Fracture risk should be re-assessed in those taking denosumab after five to 10 years. Those who remain at high risk of fractures should either continue denosumab or be treated with other osteoporosis therapies.
- Administration of denosumab should not be delayed or ceased without subsequent anti-resorptive or other therapy to prevent a rebound in bone turnover.
- Calcium and vitamin D should be used as an adjunct to osteoporosis therapies.
The guidelines are published in the Journal of Clinical Endocrinology and Metabolism.