Guidelines for diagnosis and management of osteoporosis in postmenopausal women and men at least 50 years of age in the United Kingdom have been released by the National Osteoporosis Guideline Group.
Osteoporosis Management Guidlines 2013 is an update from its 2009 guidelines on the diagnosis and management of osteoporosis. The new recommendations have been published online June 17 in Maturitas.
Here are selected highlights from these guidelines
- Bisphosphonates, denosumab, parathyroid hormone peptides, raloxifene, and strontium ranelate have been shown to lower the risk for vertebral and for hip fracture.
- Alendronate is usually first-line treatment because of its broad spectrum of antifracture efficacy and low cost.
- Ibandronate, risedronate, zoledronic acid, denosumab, raloxifene, or strontium ranelate may be appropriate therapy when alendronate is contraindicated or poorly tolerated.
- Parathyroid hormone peptides should be used only for patients at very high risk, especially for vertebral fractures.
- Postmenopausal women may benefit from calcitriol, etidronate, and hormone replacement therapy.
- Approved treatments for men at increased fracture risk are alendronate, risedronate, zoledronic acid, and teriparatide.
- Patients at increased risk for fracture should start alendronate or other bone-protective treatment at the onset of glucocorticoid therapy.
- For postmenopausal women, approved pharmacotherapy for prevention and treatment of glucocorticoid-induced osteoporosis includes alendronate, etidronate, and risedronate; approved treatment options in both sexes are teriparatide and zoledronic acid.
- Calcium and vitamin D supplementation is widely recommended for older persons who are housebound or live in residential or nursing homes and is often recommended as an adjunct to other treatments for osteoporosis.
- Potential adverse cardiovascular effects of calcium supplementation are controversial, but it may be prudent to increase dietary calcium intake and use vitamin D alone rather than using both calcium and vitamin D supplementation.
- Withdrawal of bisphosphonate treatment is associated with decreases in bone mineral density (BMD) and bone turnover after 2 to 3 years for alendronate and 1 to 2 years for ibandronate and risedronate.
- Continuation of bisphosphonates without the need for further evaluation is recommended for high-risk individuals. When bisphosphonates are continued, treatment review, including renal function evaluation, is needed every 5 years.
- If bisphosphonates are discontinued, fracture risk should be re-evaluated after every new fracture, or after 2 years if no new fracture occurs.
- After 3 years of zoledronic acid treatment, the benefits on BMD density persist for at least another 3 years after discontinuation. Most patients should stop treatment after 3 years, and their physician should review the need for continuation of therapy 3 years later.
- Persons with a previous vertebral fracture or a pretreatment hip BMD T-score of ?2.5 SD or less may be at increased risk for vertebral fracture if zoledronic acid is discontinued.
These guidelines were developed without financial support from any commercial organization.
Complete guidelines are available in the source link.
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