American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis—2020 Update

Camacho, Pauline M.; Petak, Steven M.; Binkley, Neil; Diab, Dima L.; Eldeiry, Leslie S.; Farooki, Azeez; Harris, Steven T.; Hurley, Daniel L.; Kelly, Jennifer; Lewiecki, E. Michael; Pessah-Pollack, Rachel; McClung, Michael R.; Wimalawansa, Sunil J.; Watts, Nelson B.

doi:10.4158/gl-2020-0524suppl

Cited by 573 publications

(518 citation statements)

References 363 publications

(404 reference statements)

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“…(6) Some guidelines favor ≥20 ng/ mL, whereas others recommend ≥30 ng/mL. (7,8) However, these threshold levels may not be sufficient to normalize PTH in all patients. (9) To be confident of a diagnosis of NHPT, it is necessary that serum 25-hydroxyvitamin D [25(OH)D] be within the optimal range defined by the laboratory, with a minimum level of 30 ng/ mL.…”

Section: Definition and Diagnosismentioning

confidence: 99%

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Zavatta

Clarke

2020

JBMR Plus

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Normocalcemic primary hyperparathyroidism (NHPT) was first described over 10 years ago, but uncertainties still remain about its definition, prevalence, and rates of complications. As a result, consensus management guidelines for this condition have not yet been published. Several hypotheses have been proposed for the pathophysiology of NHPT, but it may be a heterogeneous disorder with multiple causes, rather than a single etiology that explains this biochemical phenotype. A common clinical concern is whether NHPT should be treated surgically when complications are already present at first recognition of the disorder, rather than following patients clinically over time. The literature on NHPT is based mostly on larger studies of population‐based cohorts and smaller studies from referral centers. Lack of rigorous diagnostic criteria and selection bias inherent in populations seen at tertiary referral centers may explain the heterogeneity of reported rates of bone and renal complications in relation to consistently mild laboratory alterations. Unresolved questions remain about the significance of NHPT when it is diagnosed biochemically without evident bone or kidney complications. Moreover, its natural history remains to be elucidated because a proportion of what is classified as NHPT may revert to normal spontaneously, thus revealing previously unrecognized secondary hyperparathyroidism. These issues indicate that caution should be used in recommending surgery for NHPT. This review will focus on recent issues regarding the pathophysiology, evaluation, and management of NHPT. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Definition and Diagnosismentioning

confidence: 99%

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Zavatta

Clarke

2020

JBMR Plus

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“…30,31 Additionally, clinical studies have demonstrated increases in spine and hip BMD, but discontinuation of therapy results in a rapid loss of benefits after 12 to 24 months. 11 A SERM combination drug containing bazedoxifene and conjugated equine estrogen is approved also for the prevention of postmenopausal osteoporosis. This combination therapy demonstrated an increase in BMD over 24 months at the lumbar spine and hip.…”

Section: Prevention Of Fractures and Osteoporosis: Current And Emergimentioning

confidence: 99%

“…If a patient at high risk of osteoporosis is being treated for menopause with estrogen therapy or breast cancer with raloxifene, it may be appropriate to consider another agent depending on the risk-versus-benefit profile. 11 Additionally, there are concerns for compounded costs to the patient and adverse effects when using multiple agents. Sequential therapy is starting to gain traction, and there is growing literature indicating it may outperform single therapy when administered for the same time period.…”

Section: Combination and Sequential Therapymentioning

confidence: 99%

Economic implications of osteoporotic fractures in postmenopausal women

Patel¹

2020

Am J Manag Care

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According to the disclosure policy of The American Journal of Managed Care ® and Pharmacy Times Continuing Education™, all persons who are in a position to control content are required to disclose any relevant financial relationships with commercial interests. If a conflict is identified, it is the responsibility of Pharmacy Times Continuing Education™ to initiate a mechanism to resolve the conflict(s). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

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“…Consequently, there is a prolonged wait for DXA scans due to the coronavirus restrictions in the UK. DXA is an important investigation in the management of patients with osteoporosis but it is not essential for the diagnosis [ 1 ]. In December 2019 in England, 29,972 patients were waiting for a DXA, whereas after the lockdown in June 2020, this number had gone up by 50% to 45,072.…”

Section: Introductionmentioning

confidence: 99%

A pragmatic proposal for triaging DXA testing during the COVID-19 global pandemic

et al. 2020

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The COVID-19 pandemic has resulted in huge disruption to healthcare provision, including to dual-energy X-ray absorptiometry (DXA) imaging. Increased waiting lists for DXA from the pandemic mean potential long and uncertain delays in treatment for osteoporosis. To address these increased waiting lists, we propose a rapid, simple, one-stop algorithm incorporating medication use (aromatase inhibitor, corticosteroid) and clinical risk stratification supplementing a standard FRAX assessment. Our pragmatic algorithm produces a recommendation to treat empirically, image with DXA, or observe. If applied, we model a significant reduction in DXA scan requirements with a corresponding reduction in treatment delays for those awaiting DXA. We estimate this will reduce DXA scan numbers by about 50%, whilst pragmatically ensuring those with the highest clinical need correctly receive treatment without delay. This algorithm will help many clinicians including general practitioners/family physicians prioritise DXA when they may not always have the expertise to make this judgement based on clinical information alone. Although we have used UK guidelines as an example, this approach is flexible enough for adaptation by other countries based on their local guidelines, licensing, prescribing requirements, and DXA waiting list times. There are some limitations to our proposal. However, it represents one way of managing the uncertainty of the current COVID-19 pandemic.

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American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis—2020 Update

Cited by 573 publications

References 363 publications

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Economic implications of osteoporotic fractures in postmenopausal women

A pragmatic proposal for triaging DXA testing during the COVID-19 global pandemic

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