Pharmacologic treatment of osteoporosis in postmenopausal women: Endocrine Society guidelines

The Endocrine Society has released guidelines on the pharmacologic treatment of osteoporosis in postmenopausal women.

The guidelines are published in The Journal of Clinical Endocrinology and Metabolism.

Key Recommendations include:

• Postmenopausal women at high risk of fractures, especially those who have experienced a recent fracture, should be treated with pharmacological therapies, as the benefits outweigh the risks.


• In postmenopausal women at high risk of fractures, initial treatment with bisphosphonates (alendronate, risedronate, zoledronic acid, and ibandronate) is recommended to reduce fracture risk.


• In postmenopausal women with osteoporosis who are taking bisphosphonates, reassessment of the fracture risk after 3 to 5 years is recommended, and women who remain at high risk of fractures should continue therapy, whereas those who are at low-to-moderate risk of fractures should be considered for a “bisphosphonate holiday."


• Postmenopausal women with osteoporosis who are at high risk for osteoporotic fractures denosumab is recommended as an alternative initial treatment.


• In postmenopausal women with osteoporosis who are taking denosumab, fracture risk should be reassessed after 5 to 10 years and that women who remain at high risk of fractures should either continue denosumab or be treated with other osteoporosis therapies.


• In postmenopausal women with osteoporosis taking denosumab, administration of denosumab should not be delayed or stopped without subsequent antiresorptive (e.g., bisphosphonate, HT, or selective estrogen receptor modulator) or other therapy administered to prevent a rebound in bone turnover and to decrease the risk of rapid BMD loss and an increased risk of fracture.


• Teriparatide or abaloparatide treatment of up to 2 years is recommended in postmenopausal women with osteoporosis at very high risk of fracture, such as those with severe or multiple vertebral fractures for the reduction of vertebral and nonvertebral fractures.


• In postmenopausal women with osteoporosis who have completed a course of teriparatide or abaloparatide, treatment with antiresorptive osteoporosis therapies to maintain bone density gains is recommended.


• In postmenopausal women with osteoporosis at high risk of fracture and with the patient characteristics below, raloxifene or bazedoxifene to reduce the risk of vertebral fractures is recommended.


• In postmenopausal women at high risk of fracture and with the patient characteristics below, menopausal HT is recommended, using estrogen only in women with hysterectomy, to prevent all types of fractures.


• In postmenopausal women with osteoporosis at high risk of fracture and with the patient characteristics below, the use of tibolone is suggested to prevent vertebral and nonvertebral fractures.


• In postmenopausal women at high risk of fracture with osteoporosis, nasal spray calcitonin be prescribed only in women who cannot tolerate raloxifene, bisphosphonates, estrogen, denosumab, tibolone, abaloparatide, or teriparatide or for whom these therapies are not considered appropriate.


• In postmenopausal women with low BMD and at high risk of fractures with osteoporosis, calcium and vitamin D can be used as an adjunct to osteoporosis therapies.


• In postmenopausal women at high risk of fracture with osteoporosis who cannot tolerate bisphosphonates, estrogen, selective estrogen response modulators, denosumab, tibolone, teriparatide, and abaloparatide, daily calcium and vitamin D supplementation to prevent hip fractures is recommended.


• monitoring the BMD by dual-energy X-ray absorptiometry at the spine and hip every 1 to 3 years to assess the response to treatment is suggested in postmenopausal women with a low BMD and at high risk of fractures who are being treated for osteoporosis.

For detailed recommendations follow the link: https://doi.org/10.1210/jc.2019-00221