• Amir Qaseem, Lauri A Hicks, Itziar Etxeandia-Ikobaltzeta, Tatyana Shamliyan, Thomas G Cooney, Clinical Guidelines Committee of the American College of Physicians, J Thomas Cross, Nick Fitterman, Jennifer S Lin, Michael Maroto, Adam J Obley, Jeffrey A Tice, and Janice E Tufte.
• American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E., T.S.).
• Ann. Intern. Med. 2023 Feb 1; 176 (2): 224238224-238.

DescriptionThis 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.MethodsThe 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 PopulationThe audience for this guideline includes all clinicians. The patient population includes adults with primary osteoporosis or low bone mass.Recommendation 1 AACP 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 1 BACP 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 2 AACP 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 2 BACP 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 3ACP 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 4ACP 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).

26 keywords...

hide…