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Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians.

Abstract

Description

This guideline updates the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is endorsed by the American Academy of Family Physicians.

Methods

The ACP Clinical Guidelines Committee based these recommendations on a systematic review of randomized controlled trials; systematic reviews; large observational studies (for adverse events); and case reports (for rare events) that were published between 2 January 2005 and 3 June 2011. The review was updated to July 2016 by using a machine-learning method, and a limited update to October 2016 was done. Clinical outcomes evaluated were fractures and adverse events. This guideline focuses on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen. Evidence was graded according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

Target Audience and Patient Population

The target audience for this guideline includes all clinicians. The target patient population includes men and women with low bone density and osteoporosis.

Recommendation 1

ACP recommends that clinicians offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis. (Grade: strong recommendation; high-quality evidence).

Recommendation 2

ACP recommends that clinicians treat osteoporotic women with pharmacologic therapy for 5 years. (Grade: weak recommendation; low-quality evidence).

Recommendation 3

ACP recommends that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis. (Grade: weak recommendation; low-quality evidence).

Recommendation 4

ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence).

Recommendation 5

ACP recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. (Grade: strong recommendation; moderate-quality evidence).

Recommendation 6

ACP recommends that clinicians 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 benefits, harms, and costs of medications. (Grade: weak recommendation; low-quality evidence).

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Yale School of Medicine, New Haven, Connecticut.

    ,

    From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Yale School of Medicine, New Haven, Connecticut.

    ,

    From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Yale School of Medicine, New Haven, Connecticut.

    ,

    From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Yale School of Medicine, New Haven, Connecticut.

    Source

    Annals of internal medicine 166:11 2017 Jun 06 pg 818-839

    MeSH

    Bone Diseases, Metabolic
    Calcium, Dietary
    Denosumab
    Diphosphonates
    Estrogen Replacement Therapy
    Exercise
    Female
    Fractures, Bone
    Humans
    Male
    Osteoporosis
    Osteoporosis, Postmenopausal
    Raloxifene Hydrochloride
    Risk Factors
    Teriparatide
    Vitamin D

    Pub Type(s)

    Journal Article
    Practice Guideline

    Language

    eng

    PubMed ID

    28492856

    Citation

    Qaseem, Amir, et al. "Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: a Clinical Practice Guideline Update From the American College of Physicians." Annals of Internal Medicine, vol. 166, no. 11, 2017, pp. 818-839.
    Qaseem A, Forciea MA, McLean RM, et al. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017;166(11):818-839.
    Qaseem, A., Forciea, M. A., McLean, R. M., & Denberg, T. D. (2017). Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Annals of Internal Medicine, 166(11), pp. 818-839. doi:10.7326/M15-1361.
    Qaseem A, et al. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: a Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017 Jun 6;166(11):818-839. PubMed PMID: 28492856.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. AU - Qaseem,Amir, AU - Forciea,Mary Ann, AU - McLean,Robert M, AU - Denberg,Thomas D, AU - ,, Y1 - 2017/05/09/ PY - 2017/5/12/pubmed PY - 2017/6/21/medline PY - 2017/5/12/entrez SP - 818 EP - 839 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 166 IS - 11 N2 - Description: This guideline updates the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is endorsed by the American Academy of Family Physicians. Methods: The ACP Clinical Guidelines Committee based these recommendations on a systematic review of randomized controlled trials; systematic reviews; large observational studies (for adverse events); and case reports (for rare events) that were published between 2 January 2005 and 3 June 2011. The review was updated to July 2016 by using a machine-learning method, and a limited update to October 2016 was done. Clinical outcomes evaluated were fractures and adverse events. This guideline focuses on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen. Evidence was graded according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Target Audience and Patient Population: The target audience for this guideline includes all clinicians. The target patient population includes men and women with low bone density and osteoporosis. Recommendation 1: ACP recommends that clinicians offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis. (Grade: strong recommendation; high-quality evidence). Recommendation 2: ACP recommends that clinicians treat osteoporotic women with pharmacologic therapy for 5 years. (Grade: weak recommendation; low-quality evidence). Recommendation 3: ACP recommends that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis. (Grade: weak recommendation; low-quality evidence). Recommendation 4: ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence). Recommendation 5: ACP recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. (Grade: strong recommendation; moderate-quality evidence). Recommendation 6: ACP recommends that clinicians 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 benefits, harms, and costs of medications. (Grade: weak recommendation; low-quality evidence). SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/28492856/full_citation L2 - https://www.annals.org/article.aspx?doi=10.7326/M15-1361 DB - PRIME DP - Unbound Medicine ER -