What are the AACE recommendations on choosing medications to treat 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 (AACE), updated in 2020, include the following recommendations for choosing drugs to treat osteoporosis in postmenopausal women [11] :

  • First-line agents for most high fracture risk patients: alendronate, risedronate, zoledronate, denosumab

  • First-line agents for high fracture risk patients unable to use oral therapy: abaloparatide, denosumab, romosozumab, teriparatide, and zoledronate

  • First-line agents for spine-specific indications in select patients: ibandronate and raloxifene

  • Sequential agents: anabolic agents (eg, abaloparatide, romosozumab, teriparatide) should be followed with a bisphosphonate or denosumab

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