HFHT's Practising Wisely Newsletter
For the whole healthcare team.
Issue 33: Osteoporosis Update
August 15, 2017

The American College of Physicians (ACP) is a national organization of internists, the largest medical-specialty organization, and second-largest physician group in the United States. Their 152,000 members include internists, internal medicine subspecialists, medical students, residents, and fellows. The ACP has updated their guideline on osteoporosis in the last year. Check out our Quick Links section to view the full text guidelines and extensive references, and to read to the comments at the end of the document, where both sides of the osteoporosis argument are presented - it is very enlightening!

The key recommendations are highlighted below. These recommendations are worth highlighting, especially in view of the inconsistencies in both monitoring and treatment of osteoporosis in our region.

ACP recommendation 1: Clinicians should offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis. (Grade: strong recommendation; high-quality evidence)

ACP recommendation 2: Clinicians should treat osteoporotic women with pharmacologic therapy for 5 years. (Grade: weak recommendation; low-quality evidence)

ACP recommendation 3: Clinicians should offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis. (Grade: weak recommendation; low-quality evidence)

ACP recommendation 4: Clinicians should not do bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women (Grade: weak recommendation; low quality evidence)

ACP recommendation 5: Clinicians should avoid using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. (Grade: strong recommendation; moderate-quality evidence)

ACP recommendation 6: Clinicians should make the decision whether to treat osteopenic women 65 years of age or older who are at a high risk for fracture based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications. (Grade: weak recommendation; low-quality evidence)

It appears that there is a movement toward reducing treatment duration, especially in view of the increasing incidence of atypical hip fractures and also to reducing the frequency of bone density testing, as there is no evidence from random clinical trials regarding how often to monitor bone mineral density during osteoporosis treatment, and women treated with antiresorptive treatment benefited from reduced fractures with treatment even if bone mineral density did not increase.

This is a good example of the ever changing state of guidelines on a medical condition and the value of continuing medical education.

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