Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline from the American College of Physicians

Details

• Alternative Title:
  Ann Intern Med
• Personal Author:
  Qaseem, Amir ; Hicks, Lauri A. ; Etxeandia-Ikobaltzeta, Itziar ; Shamliyan, Tatyana ; Cooney, Thomas G.
• Corporate Authors:
  Clinical Guidelines Committee of the American College of Physicians*
• Description:
  Description: ; This guideline updates the 2017 American College of Physicians (ACP) recommendations on pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults. ; Methods: ; The ACP Clinical Guidelines Committee based these recommendations on an updated systematic review of evidence and graded them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. ; Audience and Patient Population: ; The audience for this guideline includes all clinicians. The patient population includes adults with primary osteoporosis or low bone mass. ; Recommendation 1a: ; ACP recommends that clinicians use bisphosphonates for initial pharmacologic treatment to reduce the risk of fractures in postmenopausal females diagnosed with primary osteoporosis (strong recommendation; high-certainty evidence). ; Recommendation 1b: ; ACP suggests that clinicians use bisphosphonates for initial pharmacologic treatment to reduce the risk of fractures in males diagnosed with primary osteoporosis (conditional recommendation; low-certainty evidence). ; Recommendation 2a: ; ACP suggests that clinicians use the RANK ligand inhibitor (denosumab) as a second-line pharmacologic treatment to reduce the risk of fractures in postmenopausal females diagnosed with primary osteoporosis who have contraindications to or experience adverse effects of bisphosphonates (conditional recommendation; moderate-certainty evidence). ; Recommendation 2b: ; ACP suggests that clinicians use the RANK ligand inhibitor (denosumab) as a second-line pharmacologic treatment to reduce the risk of fractures in males diagnosed with primary osteoporosis who have contraindications to or experience adverse effects of bisphosphonates (conditional recommendation; low-certainty evidence). ; Recommendation 3: ; ACP suggests that clinicians use the sclerostin inhibitor (romosozumab, moderate-certainty evidence) or recombinant PTH (teriparatide, low-certainty evidence), followed by a bisphosphonate, to reduce the risk of fractures only in females with primary osteoporosis with very high risk of fracture (conditional recommendation). ; Recommendation 4: ; ACP suggests that clinicians take an individualized approach regarding whether to start pharmacologic treatment with a bisphosphonate in females over the age of 65 with low bone mass (osteopenia) to reduce the risk of fractures (conditional recommendation; low-certainty evidence).
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• Keywords:
  • Male
  • Female
  • Humans
  • Adult
  • Denosumab
  • RANK Ligand
  • Fractures, Bone
  • Diphosphonates
  • Osteoporosis
  • Physicians
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• Source:
  Ann Intern Med. 176(2):224-238
• Pubmed ID:
  36592456
• Pubmed Central ID:
  PMC10885682
• Document Type:
  Text
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Genre:
  Journal Article
• Volume:
  176
• Issue:
  2
• Download URL:
  https://stacks.cdc.gov/view/cdc/149443/cdc_149443_DS1.pdf
• File Type:
  [PDF - 2.40 MB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:e1718a3d51cc4947abded59be5343a980d1d55a9ad9a45d2c5a80903ef04dc93222ff65b87e2f1a87dc6af6fb54a1c13d6a298b4560d57ec9ece9159528c499d