ACP Guidelines on Fracture Prevention in at-risk Adults Save

The American College of Physicians (ACP) has updated its 2017 recommendations on pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults. The full document and guideline can be found in the Annals of Internal Medicine. This guideline is the result of an expert panel literature review and GRADE evaluations. 

• Recommendation 1a: ACP recommends bisphosphonates for initial treatment to reduce the risk of fractures in postmenopausal females with primary osteoporosis 
• Recommendation 1b: ACP suggests bisphosphonates for initial treatment to reduce the risk of fractures in males diagnosed with primary osteoporosis 
• Recommendation 2a: ACP suggests denosumab second-tline o reduce the risk of fractures in postmenopausal females with primary osteoporosis (with contraindications to bisphosphonates)
• Recommendation 2b: ACP suggests denosumab second-line to reduce the risk of fractures in males with primary osteoporosis (with contraindications to bisphosphonates)
• Recommendation 3: ACP suggests that clinicians use the sclerostin inhibitor (romosozumab) or recombinant PTH (teriparatide)  followed by a bisphosphonate, to reduce the risk of fractures in females with primary osteoporosis with very high risk of fracture 
• Recommendation 4: ACP suggests an individualized approach to bisphosphonate use in females over the age of 65 with low bone mass (osteopenia)