More postmenopausal women could benefit from medications to treat osteoporosis despite the potential risks of some medications, according to the authors of the new guidelines released March 25, 2019, at ENDO, the annual meeting of the Endocrine Societyin New Orleans.
The document, which took five years to prepare and the first new guidance on osteoporosis in this age group in more than a decade, is also underway. Posted in the May 2019 issue of Journal of Endocrinology and Metabolism.
The guidelines address what doctors say are worrisome trends in screening and treatment for osteoporosis, which is believed to affect 54 million American adults, most of them postmenopausal women.
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Hip fractures increase with lower bone density screening
In recent years, the number of women with hip fractures has increased, while rates of bone density screening have dropped dramatically, he says Clifford J. Rosen, MD, director of the Center for Clinical and Translational Research at Maine Medical Center in Scarborough. Dr. Rosen chaired the guidelines committee.
However, one in two postmenopausal women will experience an osteoporosis-related fracture in their lifetime, Rosen says.
“That’s one of the reasons we’re concerned,” he says. Number of prescriptions for bisphosphonates [a type of osteoporosis medication] I backed down, and the screening process went down.”
Fear of rare side effects that contribute to reducing osteoporosis treatment
The decline in screening and treatment is likely related to studies over the past two decades linking serious, albeit uncommon, side effects to bisphosphonate use. The medications, which include brands such as Fosamax (alendronate) and Boniva (ibandronate), can cause an unusual type of femur fracture as well as jaw bone necrosiswhich is when the bone begins to weaken and die.
“I think patients are definitely worried, and rightly so,” Rosen says. “It’s worrying for individuals.”
The guideline committee authors spent a lot of time trying to understand patients’ concerns and medication compliance issues. Still, he says, the guidelines say treating women with the disease is worth the risk.
“It’s clear that we have safe and effective medicines,” he says. The guidelines include an algorithm to help doctors prescribe appropriate treatments for women based on their level of risk.
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New guidelines allow ‘drug abuse holiday’ for those at lower risk
In general, the guidelines call for treating postmenopausal women at risk of fracture with medication, and prescribing bisphosphonates for initial treatment.
One new change from previous guidelines is the option for some women to be off bisphosphonates after an initial period of treatment. Women should be reassessed for fracture risk three to five years after taking the drug.
Those still at risk for fractures should continue to take the medication, while women considered low to moderate risk could opt for “drug leave,” stopping the medication for a period of time followed by further evaluation.
Related: Even during the ‘drug abuse holiday’, patients with osteoporosis should be monitored
She hopes the new approach will lead to increased use of osteoporosis drugs
This approach may increase compliance — people taking medications as prescribed at the right time — Rosen says.
“We wanted to understand what individuals wanted in treatment,” he says of the guideline-writing process. “One of our biggest concerns in this area is people taking their medication.”
The guidelines also recommend the use of drugs such as Prolia (denosumab) as an alternative to bisphosphonates for initial treatment of disease in women at high risk.
Rosen noted that the review is based on the latest evidence-based science about treating osteoporosis.
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