Osteoporosis Guidelines Issued

Some scaleback of bone density testing recommended

The American College of Physicians (ACP) is recommending against bone density testing for women who are being treated for osteoporosis with bisphosphonates (alendronate, risendronate or zoledronic acid) or denusomab, a biologic agent.

In addition, the College says that the evidence fails to support frequent monitoring of women with normal bone density for osteoporosis. The data showed that most women with normal bone density measurements did not progress to osteoporosis within 15 years.

The ACP published its evidence-based clinical practice guideline in Annals of Internal Medicine. The American Academy of Family Physicians has endorsed ACP’s guideline.

Osteoporosis is a systemic skeletal disease characterized by decreasing bone mass and deterioration of bone tissue, which leads to an increased risk for bone fragility and fracture, especially in the hip, spine, and wrist, explains ACP. An estimated 54 million men and women in the United States have low bone density or osteoporosis. About 50 percent of Americans older than 50 are at risk for osteoporotic fracture.

ACP’s guideline focuses on the comparative benefits and risks of short- and long-term drug treatments for low bone density or osteoporosis, including prescriptions, calcium, vitamin D, and estrogen.

The evidence suggests that physicians should treat women with osteoporosis with drug therapy for five years, according to ACP. Continuing treatment after the initial five years may be beneficial for some patients and may be appropriate after reassessing the risks and benefits of continuing therapy.

The evidence fails to show any benefit from bone density monitoring during the five-year treatment period, says ACP. The College also recommends against using menopausal estrogen therapy or menopausal estrogen plus progestin therapy or raloxifene for the treatment of osteoporosis in women. Estrogen treatment is associated with serious harms, such as increased risk for cerebrovascular accidents and venous thromboembolic events that outweigh the potential benefits.

Physicians 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 the benefits, harms, and costs of medications.

ACP recommends that physicians offer drug treatment with bisphosphonates to reduce the risk for vertebral fracture in men with osteoporosis.

“The evidence specifically for men is sparse,” Jack Ende, M.D., MACP and president of the ACP was quoted as saying. “However, the data did not suggest that outcomes associated with drug treatment would differ between men and women if based on similar bone mineral density, so treatment for men may be appropriate.”