27 Oct Clinical Practice Guidelines For Diagnosis and Treatment of Postmenopausal Osteoporosis
MedicalResearch.com Interview with:
Dr. Pauline Camacho
Pauline Camacho, MD, FACE
Professor, Endocrinology
Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Fellowship Program Director, Endocrinology, Medical Director, Osteoporosis Center
MedicalResearch.com: What is the background for this report? What is the prevalence and significance of osteoporosis in US women?
Response: Osteoporosis is widely prevalent and is increasing in prevalence not only in the US but also around the world. 10.2 million Americans have osteoporosis and that an additional 43.4 million have low bone mass. More than 2 million osteoporosis-related fractures occur annually in the US, more than 70% of these occur in women ( from National Osteoporosis Foundation (NOF) estimates).
MedicalResearch.com: What are the main prevention and treatment recommendations?
Response: Osteoporosis is diagnosed based on the presence of a fragility fracture in the absence of another metabolic bone disorder; and a lumbar, total, femoral neck hip or distal radius BMD T-score of -2.5 or lower. Patients with osteopenia (T-score of -1.0 to -2.4) and a high fracture risk score by FRAX, may also be diagnosed with osteoporosis. All patients should undergo evaluation for causes of secondary osteoporosis. Postmenopausal women should receive 1200 mg of calcium ( from all sources) daily and vitamin D level ( 25 OHD) should be maintained between 30-50 ng/dl.
The choice of initial therapy would depend on the patient’s fracture risk. Higher fracture risk individuals include those who are older, have prior fractures, very low T-scores, are frail or are on glucorcorticoid therapy. Moderate risk individuals may be started on alendronate, risedronate, denosumab or zoledronic acid. All four agents have proven fracture risk reduction in vertebral, non-vertebral and hip sites. Alternate drugs include ibandronate and raloxifene. For higher fracture risk individuals, and injectable agent such as denosumab, teriparatide or zoledronic acid could be considered as initial therapy.
The recommended duration of therapy would also be based on the patient’s fracture risk. 5 years of oral bisphosphonates (BP) or 3 years of zoledronic acid is appropriate for moderate risk patients. For higher fracture risk patients, the recommended treatment duration is up to 10 years of oral BP or 6 years of zoledronic acid. Teriparatide therapy is limited to two years and drug holidays are not recommended for denosumab.
Bisphosphonate holidays end when there is a fracture, BMD declines beyond the least significant ( LSC) of the machine, or clinical fracture risk increases significantly. Bone turnover markers rising to pretreatment levels may also herald the end of the drug holiday.
MedicalResearch.com: Is there anything else you would like to add?
Response: Be sure to check out the algorithm ( soon to be available in app form) which encapsulates most of the guideline recommendations.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS — 2016 Pauline M. Camacho, MD, FACE; Steven M. Petak, MD, MACE, FACP, FCLM, JD; Neil Binkley, MD; Bart L. Clarke, MD, FACP, FACE; Steven T. Harris, MD, FACP Daniel L. Hurley, MD, FACE; Michael Kleerekoper, MBBS, MACE; E. Michael Lewiecki, MD, FACP, FACE; Paul D. Miller, MD; Harmeet S. Narula, MD, FACP, FACE; Rachel Pessah-Pollack, MD, FACE; Vin Tangpricha, MD, PhD, FACE; Sunil J. Wimalawansa, MD, PhD, MBA, FCCP, FACP, FRCP, DSc, FACE; Nelson B. Watts, MD, FACP, MACE
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on October 27, 2016 by Marie Benz MD FAAD