AACE/ACE Updates Postmenopausal Osteoporosis Management Guidelines

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) announced the publication of new clinical guidelines and an accompanying algorithm to help physicians and other health care professionals with the diagnosis, fracture risk assessment, and treatment of postmenopausal osteoporosis. The documents are published in Endocrine Practice. 

Currently, the Centers for Disease Control and Prevention (CDC) estimates that 16% of US women aged 50 years and older suffer from osteoporosis. However, fewer than 1 in 4 women aged 67 and older with an osteoporosis-related fracture undergo bone density measurement or start osteoporosis treatment. 

Some of the key recommendations made by the AACE/ACE include:

• All postmenopausal women aged 50 and older should undergo clinical assessment for osteoporosis and fracture risk, including a detailed history and physical examination using tools such as the World Health Organization’s (WHO) clinical fracture risk assessment (FRAX®), when available.
• Bone mineral density (BMD) testing is recommended in women aged 65 and older as well as younger postmenopausal women at increased risk for bone loss and fracture, based on fracture risk analysis.
• Because of the high prevalence of secondary osteoporosis, medical evaluation is indicated in all women with postmenopausal osteoporosis and at high fracture risk to identify coexisting medical conditions that may be causing or contributing to the patient’s bone loss.
• In terms of pharmacologic therapy, those patients with lower or moderate fracture risk can be started on oral agents, while injectable agents can be considered as initial therapy for those who have the highest fracture risk. Until the effect of combination therapy on fracture risk is better understood, AACE does not recommend such use of pharmaceutical agents for osteoporosis prevention or treatment.

In light of the growing concern about prolonged use of bisphosphonates and rare adverse events, the guidelines also include recommendations on treatment duration based on severity of osteoporosis and fracture risk.

Disclosures: Several guideline authors disclosed relationships with one or more of the following: Abbvie, AgNovos, Allergan Pharmaceuticals, Alexion, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene Corporation, Daiichi Sankyo, Eli Lilly and Company, GE Healthcare Lunar, Gilead Sciences, GrĀ1/4nenthal Group, Immunodiagnostics, Merck, Merck Serrano, National Bone Health Alliance, Nestle, Novartis, NPS Pharmaceuticals, Opko Health, OsteoDynamics, Quest Diagnostics, Radius Health, Regeneron, Roche, Sanofi, Sprout, and Ultragenyx.

Reference

1. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis. Endocr Pract. 2016;22(9):1111-1118. doi:10.4158/EP161435.ESGL.

This article originally appeared on MPR