Abstract
Purpose
The American College of Physicians (ACP) published a set of guidelines on how to prevent
fractures in men and women with low bone density or osteoporosis. As the population
ages, the overall risk of fractures increases, thus burdening the health care system.
These guidelines review current evidence for osteoporosis management, providing an
update to the previous 2008 ACP’s guidelines.
Methods
The ACP put forth 6 recommendations addressing the complexities in osteoporosis management
based on evidence available through October 2016 with a focus on bisphosphonates,
calcium, vitamin D, and estrogen. Evidence was graded according to recommended strength
by using the ACP standard methods.
Findings
The ACP recommends anti-osteoporosis therapy with 1 of 3 bisphosphonates (alendronate,
risedronate, or zoledronic acid) or denosumab in patients with osteoporosis, while
excluding anabolic therapies, and recommends against raloxifene. Although bisphosphonates
are the mainstay of treatment, anabolic therapy and raloxifene may be used in specific
situations. Pharmacologic therapy is recommended for 5 years, oversimplifying length
of therapy and failing to promote an individualized patient-centered care approach.
Moreover, abrupt discontinuation of denosumab is associated with a decline in bone
mineral density (BMD), which must be addressed. Routine monitoring of BMD by dual
x-ray absorptiometry is not endorsed during treatment, which leads to underrecognition
of management issues. Pharmacologic treatment with bisphosphonates for male osteoporosis
is recommended, although therapies such as denosumab and teriparatide are excluded.
Finally, the ACP recommends treatment for women aged ≥65 years at high risk for fracture
with osteopenia after a discussion of patient preferences, fracture risk profile,
and medications.
Implications
Osteoporosis management is complex. The 2017 ACP guidelines address challenges faced
by clinicians but oversimplify more complex issues. These are among a number of guidelines
that are available for osteoporosis management, which may be used in combination with
other sources to assist clinicians with diagnostic and management strategies.
Key words
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Article info
Publication history
Published online: November 28, 2017
Accepted:
November 14,
2017
Identification
Copyright
Published by Elsevier Inc.
