ACP releases new guidelines on the treatment of osteoporosis

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The American College of Physicians (ACP) has released new guidelines on the treatment of osteoporosis, which have been published in the Annals of Internal Medicine. The recommendations for treating osteoporosis were last published in 2008.

• Physicians should treat women with osteoporosis with bisphosphonates (alendronate, risedronate, or zoledronic acid) or denosumab, a biologic agent for five years. Continuing treatment after the initial five years may be beneficial for some patients and may be appropriate after reassessing the risks and benefits of continuing therapy.
• Bisphosphonates are also recommended in men with osteoporosis to reduce fracture risk.
• Bone density monitoring during the five-year treatment period is not recommended due to lack of evidence of the benefit of monitoring.
• Use of hormone-replacement therapy (HRT), either estrogen alone or estrogen + progestin or raloxifene for the treatment of osteoporosis in women is not recommended. The serious adverse effects of estrogen treatment such as increased risk for cerebrovascular accidents and venous thromboembolic events outweigh the potential benefits.
• The decision to treat osteopenic women 65 years of age or older at a high risk for fracture should be based on fracture risk profile; and the benefits, harms, and costs of medications and patient preference.
• Most women with normal bone density measurements do not progress to osteoporosis within 15 years; hence, ACP does not support frequent monitoring of women with normal bone density for osteoporosis

At the same time, the ACP does not recommend physicians use,

(Source: ACP Press Release, May 9, 2017)