Pharmacological management of osteoporosis in postmenopausal. Pharmacologic options for osteoporosis prevention and treatment. Patients diagnosed with osteoporosis by dexa tscore of 2. Thus, achievement of optimum bone health should be the aim throughout life, by agespecific non pharmacological intervention. Apr 02, 2019 guideline recommends pharmacologic treatment of osteoporosis in postmenopausal women at high fracture risk bisphosphonates are recommended for initial treatment, although ibandronate is not recommended for reducing nonvertebral or hip fracture risk, the clinical practice guideline from the endocrine society stated. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. Bisphosphonate or other treatment should be resumed within 5 years of stopping it or when there is evidence that the treatment is no longer working.
Nonpharmacological management of osteoporosis is a broad concept. Pharmacologic treatment of osteoporosis in postmenopausal. Due to the risk of subsequent fractures, each osteoporotic fracture is an indication for immediate initiation of pharmacological intervention. Aug 15, 2014 the clinicians guide to prevention and treatment of osteoporosis was developed by an expert committee of the national osteoporosis foundation nof in collaboration with a multispecialty council of medical experts in the field of bone health convened by nof. Nonpharmacological management of osteoporosis pdf download. Osteoporosis screening, diagnosis, and treatment guideline. Osteoporosis has been defined as a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility to fracture. Pharmacological treatment of osteoporosis in the oldest old a vandenbroucke,1 fp luyten,2,3 j flamaing,4 e gielen3,4 1clinical department of internal medicine, uz leuven, 2skeletal biology and engineering, department of development and regeneration, ku leuven, 3center for metabolic bone disease, uz leuven, 4gerontology and geriatrics, department of clinical and experimental medicine. This increased risk can be determined using the frax tool postbmd. In addition to pharmacological treatment for osteoporosis, any suspected underlying causes of bone loss should be investigated and appropriately managed. The probability of developing mainly hip, vertebral and other non. The clinicians guide to prevention and treatment of osteoporosis was developed by an expert committee of the national osteoporosis foundation nof in collaboration with a multispecialty council of medical experts in the field of bone health convened by nof. However, this benefit decreases if hormone therapy is discontinued.
If youre undergoing osteoporosis treatment, youre taking a step in the right direction for your bone health. Osteoporosis in the elderly, pharmacological and non. A bisphosphonate drug holiday is considered after 3 years of treatment with zoledronic acid if the bmd t scores is above 2. The impact of osteoporosis is most pronounced in elderly populations who run the greatest risk of fractures.
Pharmacological treatment of osteoporosis in the oldest old cia. Pharmacological treatment o f osteoporosis sungwook chun, md department of obstetrics and gynecology, inje university haeundae paik hospital, inje university college of medicine, busan, korea. Treatment of osteoporosis is strictly related to severity of pathology and consists on prevention of fragility fractures with a correct lifestyle and. The increasing incidence of fragility fractures, such as vertebral, hip, and wrist fractures, first became apparent from epidemiological studies in the earl y and. This may, in daily practice, confuse the clinician. Fdaapproved medications for osteoporosis treatment treatment of osteoporosis should always include. The aim of this study is to highlight and identify osteoporosis in the elderly as well as to analyze on the current risk factors causing osteoporosis and pharmacological prevention and treatment. Osteoporosis treatment may involve medication along with lifestyle change. This article describes current osteoporosis screening recommendations, pharmacological interventions, and a collaborative approach to treatment.
Osteoporosis, a chronic, progressive disease of multifactorial etiology see etiology, is the most common metabolic bone disease in the united states. Osteoporosis screening and treatment guideline recommendations are currently underutilized resulting in a public health concern. Thus, most patients who meet criteria for pharmacological treatment2 are offered bisphosphonates at standardised doses as firstline therapy. Guideline recommends pharmacologic treatment of osteoporosis in postmenopausal women at high fracture risk bisphosphonates are recommended for initial treatment, although ibandronate is not recommended for reducing nonvertebral or hip fracture risk, the clinical practice guideline from the endocrine society stated. Guidelines on the pharmacologic treatment of osteoporosis in postmenopausal women were released by the endocrine society on march 25, 2019.
Evidence from clinical trials and insights from clinical experience with pharmacologic therapies for osteoporosis were critically evaluated in formulating this guideline for the management of postmenopausal osteoporosis. Treatment of osteoporosis is strictly related to severity of pathology and consists on prevention of fragility fractures with a correct lifestyle and adequate nutritional supplements, and use of pharmacological therapy, started in patients with osteopenia and history of fragility fracture of the hip or spine. Although a number of effective drugs are available for the treatment of osteoporosis,1 the therapeutic strategy for fracture prevention has generally been rather simplisticie, a onesizefitsall approach. Providing a description of independent and adjuvant techniques and practices for treatment and improving quality of life, nonpharmacological management of osteoporosis is an excellent resource for endocrinologists, bone specialists, physical therapists, occupational therapists and all clinical practitioners and staff working with osteoporosis. The purpose of pharmacological treatment in osteoporosis is to reduce the risk of fracture. Zoledronic acid is also indicated for the prevention of new clinical fractures in patients both women and men. Get answers to some of the most common questions about osteoporosis treatment.
Pharmacological treatment should then be considered if the fracture risk is too high. Pharmacological treatments that primarily and effec tively reduce bone loss and fracture risk have become avail able in the last few decades. What are the acp recommendations for pharmacologic. Postmenopausal women at high fracture risk, particularly patients with a recent fracture, should be treated with pharmacologic. Treat high risk individuals particularly those with previous. A variety of nonhormonal pharmacological options are available for prevention and treatment of osteoporosis, osteoporosis treatment. Pharmacological treatment of osteoporosis intechopen. Providing a description of independent and adjuvant techniques and practices for treatment and improving quality of life, nonpharmacological management of osteoporosis is an excellent resource for endocrinologists, bone specialists, physical therapists, occupational therapists and all clinical practitioners and staff working with osteoporosis patients. Thereafter, treatment of osteoporosis includes 1 prevention of further bone loss through weightbearing exercise, tobacco and alcohol avoidance, hormone replacement.
Pharmacological treatment in primary osteoporosis is undertaken when the 10year fracture risk exceeds 20% and following an osteoporotic fracture. Pharmacological treatment of osteoporosis 571 besides, it is a secure treatment that eludes the gastrointestinal adverse events and the bad adherence that are usually seen with other bisfosfonates. Methods for its prevention and treatment are discussed in detail for both pharmacological and nonpharmacological approaches. Apr 02, 2020 a clinical practice guideline from the american college of physicians acp recommends offering pharmacologic treatment to women with known osteoporosis, to reduce the risk of hip and vertebral. All persons who have had osteoporotic vertebral or hip fractures and those with a bone mineral density diagnostic of osteoporosis should receive treatment. Osteoporosis, however, is a multifactorial disease, and skeletal fragility results from various factors. To further improve pharmacological interventions and therapeutical choices in. The pathogenesis is useful to understand the possible mechanism of action of antiosteoporotic drugs. Nonpharmacological management of osteoporosis download. Full text pharmacological treatment of osteoporosis in. The efficacy fracture risk reduction of medications. A clinical practice guideline from the american college of physicians acp recommends offering pharmacologic treatment to women with known.
Naturopathic approaches to preventing and treating. Thus, achievement of optimum bone health should be the aim throughout life, by agespecific nonpharmacological intervention. New approaches to pharmacological treatment of osteoporosis kristina akesson1 abstract osteoporosis has been recognized as a major public health problem for less than two decades. What are the acp recommendations for pharmacologic treatment. Osteoporosis a current view of pharmacological prevention.
Apr 28, 2020 all persons who have had osteoporotic vertebral or hip fractures and those with a bone mineral density diagnostic of osteoporosis should receive treatment. Mar 26, 2019 the endocrine society has released new guidelines on the pharmacologic treatment of osteoporosis in postmenopausal women. Pdf on feb 24, 2012, jorge maloufsierra and others published pharmacological treatment of osteoporosis find, read and cite all the research you need on. Full text pharmacological treatment of osteoporosis in the. Nonpharmacological management of osteoporosis exercise. Early diagnosis, possible with several laboratory and instrumental tests, allows a major accuracy in the choice of antiosteoporosis drugs. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the postfracture rehabilitation. Exercise nutrition fall and fracture prevention pdf author mehrsheed sinaki isbn 3319540149 file size 6. Health care guideline diagnosis and treatment of osteoporosis. In a dosage of 20 mcg per day given subcutaneously for up to two years, teriparatide decreases vertebral and nonvertebral fractures.
Clinicians guide to prevention and treatment of osteoporosis. There is lack of knowledge and implementation of recommendations for nonpharmacological treatment. Chen, 2015 pharmacologic treatment icsi work group consensus recommendation bisphosphonates should be considered in postmenopausal women and men with osteopenia and increased fracture risk as well as patients with glucocorticoidinduced osteoporosis. This practical guide presents the most uptodate information on the application of non. In addition, many women refuse hormone therapy due to other known or perceived adverse effects. The goal of osteoporosis treatment is the prevention of fragility fracture. According to the world health organization s more than half of the patients suffering a fragility fracture do not have densitometric osteoporosis. Yes yes na offer pharmacologic treatment for primary osteoporosis, and treat the secondary cause or consider an econsult with endocrinology. It is important for clinicians to be knowledgeable of the benefits and adverse events associated with each therapy and to individualize therapy for their patients. Pharmacological treatment of osteoporosis in the oldest old a vandenbroucke,1 fp luyten,2,3 j flamaing,4 e gielen3,4 1clinical department of internal medicine, uz leuven, 2skeletal biology and engineering, department of development and regeneration, ku leuven, 3center for metabolic bone disease, uz leuven, 4gerontology and geriatrics, department of clinical and experimental medicine, ku leuven.
It is limited to one year of treatment, followed by other osteoporosis medications. These categories are generally associated with low absolute risk of fracture, but treatment decisions should be made on the basis of individual risk osteoporosis due to secondary causes. In those with a bone mineral density above the osteoporosis range, treatment may be indicated depending on the number and severity of other risk factors. It is given as an injection every month at your doctors office. It has been most frequently recognized in elderly white women, although it does occur in both sexes, all races, and all age groups. Of osteoporosis osteoporosis prevention and management report. Pharmacological treatment of osteoporosis in the oldest. Pharmacological management of osteoporosis in postmenopausal women jcem. The topic also includes surgical procedures for the treatment of peripheral and. New approaches to pharmacological treatment of osteoporosis. Diagnosis and management of osteoporosis american family. In men with osteoporosis, alendronate reduces vertebral fracture risk a probably class effect d.
Osteoporosis remains undertreated in australian primary care, with as few as 30% of postmenopausal women with a fracture and 10% of men with osteoporosis receiving pharmacological treatment. Non pharmacological management of osteoporosis is a broad concept. Pdf pharmacological treatment of osteoporosis jorge. Jul 01, 2011 a variety of nonhormonal pharmacological options are available for prevention and treatment of osteoporosis, osteoporosis treatment. Nonpharmacological interventions for osteoporosis treatment. Methods for its prevention and treatment are discussed in detail for both pharmacological and non pharmacological approaches. Personalising osteoporosis treatment for patients at high. It is based largely on updated information on the u. This is the newest bonebuilding medication to treat osteoporosis.
Postmenopausal women at high risk of fracture, particularly recent fracture patients, should be treated with pharmacological therapies. Pdf effect of pharmacological treatment of osteoporosis. The endocrine society has released new guidelines on the pharmacologic treatment of osteoporosis in postmenopausal women. Effect of pharmacological treatment of osteoporosis in the prevention of pathological vertebral fractures. The 2019 guideline on pharmacological management of osteoporosis in postmenopausal women. Emphasizes assessment after being on treatments to see if further treatment is necessary. Numerous pharmacologic agents are available for the prevention and treatment of postmenopausal osteoporosis, as well as the treatment of osteoporosis in men and giop. Provides recommendations for the treatment and management of osteoporosis in postmenopausal women. Providing a description of independent and adjuvant techniques and practices for treatment and improving quality of life, non pharmacological management of osteoporosis is an excellent resource for endocrinologists, bone specialists, physical therapists, occupational therapists and all clinical practitioners and staff working with osteoporosis. In those with a bone mineral density above the osteoporosis range, treatment may be indicated depending on. Osteoporosis prevention and age concern kenya abstract. Prevention and treatment of postmenopausal osteoporosis. Pharmacological treatment of osteoporosis for people over. May 31, 20 osteoporosis was a huge global problem both socially and economically in the uk alone, in 2011.
This article presents an overview of the pharmacological management of osteoporosis in older people in the general practice setting. This manuscript offers an evidencebased update of previous treatment guidelines, with a critical assessment of the currently available efficacy data on all new chemical entities which were granted a marketing authorization. Guideline recommends pharmacologic treatment of osteoporosis. Pharmacologic therapy for osteoporosis treatment and prevention. Aug 15, 2015 a decrease in bmd could suggest treatment nonadherence, inadequate calcium or vitamin d intake, an unidentified secondary cause of osteoporosis, or treatment failure. Management of therapies for osteoporosis in postmenopausal women. Where secondary osteoporosis is identified, priority is given to the treatment of the primary condition. The initial stage of the pharmacological treatment of osteoporosis is to identify the pathology of the primary condition or to determine whether the loss of bone density is a secondary symptom of a separate condition. Osteoporosis is the most common bone disease affecting millions of people worldwide, particularly in elderly or in postmenopausal women. This should be achieved through a multidisciplinary treatment that includes pharmacological and nonpharmacological interventions. Where secondary osteoporosis is identified, priority. May 07, 2019 guidelines on the pharmacologic treatment of osteoporosis in postmenopausal women were released by the endocrine society on march 25, 2019. Exercise nutrition fall and fracture prevention content this practical guide presents the most uptodate information on the application of non pharmacological and physical therapeutic measures, either used independently or in combination with pharmacotherapy, for the management of osteoporosis. Pdf pharmacological treatment of osteoporosis researchgate.