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Guidelines for Osteoporosis Management in Postmenopausal Women

New guidelines on the  "Pharmacologic Management of Osteoporosis in Postmenopausal Women," were presented March 25 at ENDO 2019 - The Endocrine Society Annual Meeting and simultaneously published online in the Journal of Clinical Endocrinology & Metabolism. 

This new guideline provides recommendations for the treatment and management of osteoporosis in postmenopausal women and emphasizes ongoing assessment after treatment initiation to see if further treatment is necessary.

Some of the new recommendations include optimization of lifestyle and nutrition for bone health, and assessments of 10-year fracture risk according to country-specific guidelines.

As in the past, bisphosphonates and denosumab are still advised as first-line therapies. But the Endocrine Society now recommends anabolic treatments — teriparatide or abaloparatide (Tymlos, Radius Health) — as first-line therapy for patients with very severe osteoporosis, multiple fractures, and/or very low bone density.

Differences between these and ACP’s 2017 Guidelines are discussed in the linked Medscape article.

Essentials (Take Home Messages)

  • Treat high risk individuals - particularly those with previous fracture.
  • Consider bisphosphonates as the first line therapeutic choice for postmenopausal women at high risk of fracture.
  • Reassess fracture risk after patient has been on bisphosphonates for 3-5 years.
  • Following reassessment, prescribe a “bisphosphonate holiday” for women who are on bisphosphonates and are low-to-moderate risk of fracture.
  • Consider anabolic therapy (teriparatide or abaloparatide) for women at very high risk of fractures, including those with multiple fractures.
  • All women undergoing treatment with osteoporosis therapies other than anabolic therapy should consume calcium and vitamin D in their diet or via supplements.
  • Monitor the BMD of high-risk individuals with a low BMD every 1 to 3 years.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

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