Pharmacologic Treatment of Osteoporosis in Postmenopausal Women Clinical Practice Guidelines (2019)

Endocrine Society

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

May 07, 2019

Guidelines on the pharmacologic treatment of osteoporosis in postmenopausal women were released by the Endocrine Society on March 25, 2019.[1]

Postmenopausal women at high risk of fracture, particularly recent fracture patients, should be treated with pharmacological therapies.

Bisphosphonates (alendronate, risedronate, zoledronic acid, and ibandronate) should be used in postmenopausal women at high risk of fractures in order to reduce fracture risk. Ibandronate should not be used to reduce fracture risk in cases of nonvertebral or hip fracture.

Reassess fracture risk after 3 to 5 years in postmenopausal osteoporosis patients on bisphosphonates. Continue bisphosphonate treatment for high-risk patients. Bisphosphonate treatment should be temporary discontinued for women who have a low-to-moderate risk of fracture.

Denosumab can be used as an alternative initial treatment in high-risk postmenopausal osteoporosis patients. Reassess fracture risk after 5 to 10 years in postmenopausal osteoporosis patients on denosumab. Following reassessment, women who are still high risk should continue treatment with denosumab or other therapies.

Teriparatide or abaloparatide treatment should be used in high-risk postmenopausal osteoporosis patients with severe or multiple vertebral fractures for up to 2 years in order to reduce fractures.

Treatment with antiresorptive osteoporosis therapies, in order to preserve bone density gains, should be used in postmenopausal patients with osteoporosis who have finished a course of teriparatide or abaloparatide.

Raloxifene or bazedoxifene should be used in order to reduce the risk of vertebral fractures in patients at low risk for deep vein thrombosis and for whom bisphosphonates or denosumab are not recommended. Raloxifene or bazedoxifene should also be used in patients who are high risk for breast cancer.

A calcium and vitamin D diet or supplementation is recommended for all women taking osteoporosis therapies with the exception of anabolics.

Bone mineral density monitoring by dual-energy X-ray absorptiometry at the spine and hip is recommended every 1 to 3 years to assess treatment response.

For more Clinical Practice Guidelines, please go to Guidelines.

For more information, go to Menopause.

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