Tuesday, 16 Jul 2019

You are here

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

Add new comment

More Like This

Safety Concerns Offset the Modest Improvements of Tanezumab in Osteoarthritis

JAMA reports that although tanezumab is modestly effective in moderate to severe osteoarthritis (knee or hip), with statistically significant improvements in pain and physical function, the tanezumab (TNZ) treated patients had more joint safety events and total joint replacements than patients treated with placebo.

Benefits vs Harms for Osteoporosis Drug Continuation or Discontinuation

While it is clear that long-term bisphosphonate therapies reduce fracture risk in women with osteoporosis, it is unclear how to counter-balance these benefits against rare serious harms and how to optimize therapeutic benefits with appropriate drug holidays. A systematic analysis of 48 studies compared long-term osteoporosis drug treatment (ODT) (>3 years) versus control versus ODT continuation versus durg discontinuation, to examine incident fractures or harms.

Mortality from Falls in the Elderly

JAMA reports that there is a trend of increasing mortality from falls in older US adults between 2000 to 2016 and that mortality rates are increased with increasing age. 

Knee Injuries Increases Osteoarthritis Risk

A systematic review of the medical literature shows anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury significantly increases the risk of future knee osteoarthritis (OA).

The metanalysis comprised 53 studies and nearly 1 million participants, including 185,219 with ACL injury (mean age 28 years), 83,267 with meniscal injury (mean 38 years) and 725,362 with combined injury (mean 31 years).

Additive Effects of Insomnia and Depression on Osteoarthritis

A study of osteoarthritis patients, finds that pain is the primary driver for health care utilization, and that the presence of insomnia or depression augments health care use.

 A total of 2976 OA patients were followed for 3 years and assessed for pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire‐8), and health care use (from electronic health records).