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by Dr.C.H. Weaver M.D. 4/2019

New guidelines on the "Pharmacologic Management of Osteoporosis in Postmenopausal Women," were released at The Endocrine Society Annual Meeting and published online in the April 2019, Journal of Clinical Endocrinology & Metabolism.

The new guidelines emphasize optimization of lifestyle and nutrition for bone health and encourage ongoing assessment after treatment initiation to see if further treatment is really necessary.

The bisphosphonates and Prolia (denosumab) are still the recommended first-line therapies however The Endocrine Society now recommends Forteo (teriparatide) or Tymlos (abaloparatide) as first-line therapy for women with very severe osteoporosis, multiple fractures, and/or very low bone density.

Key Points

· Treat high risk individuals - particularly those with previous fracture.

· Consider bisphosphonates as the first line therapeutic choice for postmenopausal women at high risk of fracture.

· Reassess fracture risk after patient has been on bisphosphonates for 3-5 years.

· Following reassessment, prescribe a “bisphosphonate holiday” for women who are on bisphosphonates and are low-to-moderate risk of fracture.

· Consider anabolic therapy (teriparatide or abaloparatide) for women at very high risk of fractures, including those with multiple fractures.

· All women undergoing treatment with osteoporosis therapies other than anabolic therapy should consume calcium and vitamin D in their diet or via supplements.

· Monitor the BMD of high-risk individuals with a low BMD every 1 to 3 years.