AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS—2020 UPDATE EXECUTIVE SUMMARY

Abstract

Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPG). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) EL 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very high-risk features, a new dual action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of postmenopausal osteoporosis.

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…There is no general consensus on the clinical significance of possible detrimental effects of gastric acid-lowering drugs on the bone metabolism, BMD, falls and OFs. The acid-suppressive medications have been considered as a factor contributing to OFs by the American National Osteoporosis Foundation [ 317 , 318 ], while the American Gastroenterological Association (AGA) did not recommend routine screening or monitoring of BMD in PPI users [ 280 ].…”

Comparison of efficacy and safety of Chinese patent medicine in the treatment of postmenopausal osteoporosis

“…According to the PMOP Diagnostic Criteria 21 issued by the American Association of Clinical Endocrinologists (AACE), [ 25 ] we will include patients diagnosed with PMOP, regardless of age, race, ethnicity, primary disease, or Clinical stage.…”

A Spontaneous Atypical Femoral Fracture after 2 decades of antiresorptive therapy

“…If fracture risk remains high or there is an interval fracture, treatment may be continued for an additional 5 years. Recent guidance from the American Association of Clinical Endocrinologists now suggests consideration of a Bisphosphonate pause after 6 to 10 years of stability in patients with a very high risk of fracture [8]. In most cases such AFFs seldom heal without surgical treatment [9].…”