ACP Updates Guidelines on Treating Low Bone Density, Osteoporosis

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Clinicians should offer alendronate, risedronate, zoledronic acid, or denosumab to women with osteoporosis to reduce the risk for hip and vertebral fractures (strong recommendation), according to updated guidelines on osteoporosis treatment from the American College of Physicians.

Among the other recommendations, published in the Annals of Internal Medicine:

• Menopausal hormone therapy should not be prescribed to treat osteoporosis in women (strong recommendation).

• Pharmacologic treatment of osteoporotic women should last for 5 years (weak recommendation). Generic drugs should be used when possible.

• Bone mineral density (BMD) monitoring during the 5-year treatment period is not advised, as evidence suggests that women see fracture-reduction benefits regardless of BMD changes (weak recommendation).

• Clinicians should offer bisphosphonate therapy to men with clinically recognized osteoporosis (weak recommendation). Evidence is lacking on BMD monitoring in men.

• For osteopenic women aged 65 and older at high fracture risk, decisions to treat should take into account patient preference, fracture-risk profile, benefits, harms, and price of medications (weak recommendation).