What are the ACP guidelines for prevention of fractures in patients with osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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A clinical practice guideline from the American College of Physicians on treatment to prevent fractures in men and women with low bone density or osteoporosis.includes six recommendations: two strong recommendations, based on high- or moderate-quality evidence, and four weak ones, based on low-quality evidence. [144] The two strong recommendations are as follows:

  • Clinicians should offer pharmacologic treatment to women with known osteoporosis to reduce the risk for hip and vertebral fractures; alendronate, risedronate, zoledronic acid, or denosumab may be used.
  • In postmenopausal women, estrogen or estrogen plus progestogen or raloxifene should not be used for the treatment of osteoporosis.

The four weak recommendations are as follows:

  • In women with osteoporosis, pharmacologic treatment should last for 5 years; generic drugs should be used when possible.

  • Monitoring of bone mineral density (BMD) during the 5 years of treatment in women with osteoporosis is not advised, as evidence suggests that fracture risk may be reduced regardless of BMD changes

  • For women aged 65 and older who have osteopenia and are at high fracture risk, decisions to treat should take into account patient preference, fracture-risk profile, benefits, harms, and price of medications

  • In men with clinically recognized osteoporosis, clinicians should offer bisphosphonate therapy to reduce the risk of vertebral fracture; evidence is lacking on BMD monitoring in men.

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