Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline

Abstract

Objective The objective is to formulate clinical practice guidelines for the pharmacological management of osteoporosis in postmenopausal women. Conclusions Evidence from clinical trials and insights from clinical experience with pharmacologic therapies for osteoporosis were critically evaluated in formulating this guideline for the management of postmenopausal osteoporosis. Patient preferences, data on adherence and persistence, and risks and benefits from the patient and provider perspectives were also considered in writing committee deliberations. A consensus by the Writing Committee members was achieved for four management principles: (i) The risk of future fractures in postmenopausal women should be determined using country-specific assessment tools to guide decision-making. (ii) Patient preferences should be incorporated into treatment planning. (iii) Nutritional and lifestyle interventions and fall prevention should accompany all pharmacologic regimens to reduce fracture risk. (iv) Multiple pharmacologic therapies are capable of reducing fracture rates in postmenopausal women at risk with acceptable risk-benefit and safety profiles.

Dracorhodin perchlorate inhibits osteoclastogenesis through repressing RANKL‐stimulated NFATc1 activity

“…16 However, imbalance of activities between these two types of cells can occur under certain situations, for example, postmenopausal women have higher risks of developing osteoporosis than other population due to oestrogen deficiency. 16,17 There are limited options of the treatment of osteoporosis which is of huge threat to the patients' well-being and causing enormous socio-economic burdens. [18][19][20] Osteoclasts are originated from the haematopoietic stem cells.…”

Where Does Denosumab Stand in the Treatment of Glucocorticoid‐Induced Osteoporosis? Comment on the Article by Saag et al

“…Osteoporosis in the setting of GIOP can be challenging to treat because of issues with drug adherence (due to pill burden) and the presence of multiple comorbidities. Denosumab is a welcome addition to the treatment regimens for this disease due to its once per 6 months dosing schedule, which is associated with better adherence than bisphosphonates (2), and its renal safety (3). However, certain clarifications may further help readers to understand its applicability when choosing it as an alternative therapy.…”

“…First, in postmenopausal women with osteoporosis, denosumab discontinuation is associated with a severe rebound effect that lasts <2 years (2)(3)(4), which combines an increase in bone turnover markers, complete loss of gained bone density, and an increased risk (from >1% to <10%) of multiple vertebral fractures. In 70 women with multiple vertebral fractures after denosumab discontinuation, the median number of vertebral fractures was 5 within 7-20 months following the last denosumab injection (4).…”

Unilateral primary aldosteronism as an independent risk factor for vertebral fracture

“…Primary aldosteronism increases the risk of vertebral fracture (VF), which not only considerably decreases quality of life, but also shortens patient survival . PA is also associated with secondary osteoporosis, which may be reversed by optimal management .…”

“…also shortens patient survival. 9 PA is also associated with secondary osteoporosis, which may be reversed by optimal management. [10][11][12][13] Since PA induces bone fragility even in patients who display a normal bone mineral density (BMD), 7 fracture risk may be underestimated if only BMD values are considered.…”