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ACP Updates Living Guideline on Pharmacologic Treatment of Osteoporosis

Bisphosphonates strongly recommended for initial treatment of primary osteoporosis for postmenopausal women

By Elana Gotkine HealthDay Reporter

TUESDAY, Jan. 3, 2023 (HealthDay News) — In a living clinical guideline issued by the American College of Physicians (ACP) and published online Jan. 3 in the Annals of Internal Medicine, updated recommendations are presented for the pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults.

Based on a systematic review and grading of the evidence, Amir Qaseem, M.D., Ph.D., from ACP in Philadelphia, and colleagues developed four recommendations. To reduce the risk for fractures in postmenopausal women diagnosed with primary osteoporosis, ACP strongly recommends use of bisphosphonates for initial pharmacologic treatment; for men diagnosed with primary osteoporosis, bisphosphonates are suggested for initial pharmacologic treatment to reduce the risk for fracture. For postmenopausal women and for men diagnosed with primary osteoporosis who have contraindications to or experience adverse effects of bisphosphonates, the receptor activator of nuclear factor κB ligand inhibitor denosumab is suggested as second-line pharmacologic treatment. For women with primary osteoporosis with a very high risk for fracture, the sclerostin inhibitor romosozumab or recombinant human parathyroid hormone teriparatide, followed by a bisphosphonate, is suggested. For women older than the age of 65 years with osteopenia, an individualized approach regarding whether to start pharmacologic treatment with a bisphosphonate is suggested.

“Future studies should aim to identify which patients will benefit from medication, and when to initiate an anabolic medication versus a bisphosphonate,” write the authors of an accompanying editorial.

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