What are the AACE recommendations for drug selection in the treatment of osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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Guidelines from the American Association of Clinical Endocrinologists/American College of Endocrinology include the following recommendations for choosing drugs to treat postmenopausal osteoporosis [11] :

  • First-line agents for most high fracture risk patients: alendronate, risedronate, zoledronic acid, ibandronate, raloxifene (latter two not recommended for the reduction of nonvertebral or hip fracture risk)
  • First-line agents for spine-specific indications in select patients: ibandronate and raloxifene
  • First-line agents for high fracture risk patients unable to use oral therapy: zoledronic acid, denosumab
  • First-line agents for very high fracture risk, including those with multiple fractures: teriparatide, abaloparatide for up to two years, romosozumab for up to one year (should not be considered in women at high risk of cardiovascular disease or stroke)
  • Sequential agents: anabolic agents (eg, abaloparatide, teriparatide, romosozumab) should be followed with a bisphosphonate or denosumab

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