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• Posted January 3, 2023

Doctors' Group Updates Guidelines on Treating Osteoporosis

As millions of Americans born in the baby boomer generation are already finding out, bone loss is a common sign of aging.

And now experts at the American College of Physicians (ACP) -- one of the leading groups representing primary care doctors -- is issuing updated guidelines on how best to prevent and treat weakening bones.

"Osteoporosis is a systemic skeletal disease characterized by decreasing bone mass and deterioration of bone tissue that leads to an increased risk for bone fragility and fracture, especially in the hip, spine, and wrist," the ACP explained in a news release.

The ACP estimates that over 10 million Americans older than 49 currently have osteoporosis, while another 43.3 million have low bone mass that could progress to full-blown osteoporosis.

The new guidelines, published Jan. 2 in the Annals of Internal Medicine, were based in part on new data on the safety and effectiveness of a variety of newer classes of drugs. Those medicines include human parathyroid hormone-related peptides and sclerostin inhibitors, the group said.

However, the guidelines maintain that the "first-line" treatment for postmenopausal women with diagnosed osteoporosis, as well as any men diagnosed with the condition, should involve a long-used class of drugs known as bisphosphonates.

Bisphosphonates include well-known medicines such as alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva).

Using bisphosphonates first "had the most favorable balance between benefits, harms, patient values and preferences, and cost among the drug classes that were evaluated," the ACP explained.

"In addition to net clinical benefits, bisphosphonates are much cheaper than other pharmacologic treatments and are available in generic oral and injectable formulations," the group added.

Still, bisphosphonate treatment does have its limits. For example, when used beyond three to five years, any benefit from the drugs in terms of reduced fractures of the hip, wrist and other locales begins to fade, although benefits in preventing spinal fractures were maintained.

"Therefore, clinicians should consider stopping bisphosphonates after five years of treatment unless there is a strong indication to continue treatment," the ACP recommended.

Other medicines may come into play as "second-line" treatment. For example, a drug called denosumab (Prolia), from a class of medicines called RANK ligand inhibitors, could be used in patients with early osteoporosis who can't take a bisphosphonate drug.

And for women whose osteoporosis puts them at very high risk of fracture, the ACP recommends other medicines, such as a sclerostin inhibitor (romosozumab/Evenity) or recombinant PTH (teriparatide/Forteo), followed by the use of a bisphosphonate drug.

Of course, the guidelines could change over time as new evidence emerges.

"ACP's Clinical Guidelines Committee is planning to maintain this topic as a living guideline with literature surveillance and periodic updating of the systematic review and the clinical recommendations," the group said.

More information

Find out more about osteoporosis at the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

SOURCE: American College of Physicians, news release, Jan. 2, 2023