ACP recommends bisphosphonates for men, postmenopausal women with primary osteoporosis - Healio

In an update to its guidance connected superior osteoporosis, ACP recommended bisphosphonates arsenic a archetypal enactment of defence to trim fracture hazard successful men and postmenopausal women.

The caller guideline, published successful Annals of Internal Medicine, is based connected an updated systematic reappraisal of grounds that included 34 randomized objective trials and 36 observational studies assessing the comparative effectiveness of assorted treatments.

Data derived from: Qaseem A, et al. Ann Intern Med. 2023;doi:10.7326/M22-1034.

Chelsea Ayers, MPH, a elder probe subordinate astatine the Center to Improve Veteran Involvement successful Care, VA Portland Health Care System, and colleagues recovered that, successful men and postmenopausal women with superior osteoporosis, “bisphosphonates had the astir favorable equilibrium betwixt benefits, harms, diligent values and preferences,” according to an ACP property release.

Notably, ACP said that bisphosphonates besides confer benefits successful that they “are overmuch cheaper than different pharmacologic treatments and are disposable successful generic oral and injectable formulations.”

“Bone fractures resulting from osteoporosis are associated with superior morbidity and mortality, and radical with a past of osteoporotic bony fractures are astatine overmuch higher hazard of aboriginal fractures,” Ryan D. Mire, MD, MACP, president of ACP, said successful the release. “This line volition assistance clinicians find the champion people of attraction for their patients to champion debar bony fractures.”

The proposal of bisphosphonates for postmenopausal women is simply a beardown proposal based connected high-certainty evidence, whereas the proposal for men is conditional, with low-certainty evidence, according to ACP.

The enactment noted that extending the duration of bisphosphonate therapy past 3 to 5 years mightiness trim the hazard for caller vertebral fractures but not others, though “there is an accrued hazard of semipermanent harms.” So, providers should see stopping therapy aft 5 years “unless determination is simply a beardown denotation to proceed treatment,” ACP said.

The line underscores the value of adults with osteoporosis adhering to the “recommended pharmacologic treatments and steadfast manner modifications,” which see workout and counseling for autumn valuation and prevention, according to the release.

ACP additionally recommended that clinicians usage the RANK ligand inhibitor denosumab arsenic a second-line attraction to trim fracture hazard successful men and postmenopausal women who person contraindications oregon experienced adverse events from bisphosphonates.

In women who person a precise precocious fracture risk, the ACP recommended the recombinant quality parathyroid hormone teriparatide (low-certainty evidence) oregon the sclerostin inhibitor Evenity (romosozumab, Amgen; moderate-certainty evidence), followed by a bisphosphonate.

Finally, the ACP recommended that clinicians usage “an individualized approach” erstwhile they are deciding whether to initiate bisphosphonate attraction successful women aged older than 65 years with debased bony mass.

In an accompanying editorial, Susan M. Ott, MD, of the Bone and Joint Center and a prof of medicine astatine the University of Washington successful Seattle, wrote that grounds connected bisphosphonates “may look overwhelmingly positive, starring to beardown recommendations for their usage to dainty osteoporosis, but the determination to commencement a bisphosphonate is really not that easy.”

“A beardown proposal should beryllium fixed lone erstwhile aboriginal studies are improbable to alteration it. Yet, information already suggest that, successful patients with superior osteoporosis, attraction should commencement with anabolic medications due to the fact that erstwhile attraction with either bisphosphonates oregon denosumab volition forestall the anabolic effect of newer medications,” Ott wrote. “Fewer fractures are seen erstwhile the archetypal attraction is an anabolic medicine, which increases bony measurement and not conscionable bony density.”

Ott besides wrote that “it is unfortunate that the reappraisal and recommendations bash not code estrogen,” due to the fact that it is “one of the astir effectual medications to forestall osteoporotic fractures.”

“Both observational studies and objective trials amusement beneficial skeletal effects of estrogen; those with capable powerfulness amusement fracture reduction,” Ott wrote. “In 1991, I reviewed each of the objective and preclinical studies of estrogen for a league of the Federal Drug Administration and was struck by uncovering that they each showed affirmative effects. It was the slightest arguable topic. Since then, observational studies person shown benefits of estrogen to the skeleton, adjacent aft 3 decades of use.”

References:

• American College of Physicians recommends bisphosphonates for archetypal attraction for osteoporosis successful males and postmenopausal females diagnosed with superior osteoporosis. https://www.acponline.org/acp-newsroom/american-college-of-physicians-recommends-bisphosphonates-for-initial-treatment-for-osteoporosis-in. Published Jan. 3, 2023. Accessed Jan. 3, 2023.
• Ayers C, et al. Ann Intern Med. 2023;doi:10.7326/M22-0684.
• Ott SM, et al. Ann Intern Med. 2023;doi:10.7326/M22-3580.
• Qaseem A, et al. Ann Intern Med. 2023;doi:10.7326/M22-1034.