ACP issues guideline for drug treatment of men and women with osteoporosis or low bone density

The American College of Physicians (ACP) today released a new clinical practice guideline on drug treatment of osteoporosis or low bone density to prevent fracture in men and women. The guideline appears in the September 16, 2008, issue of Annals of Internal Medicine. ACP recommends that physicians offer drug treatment to men and women who have been diagnosed with osteoporosis or a previous fracture not caused by substantial trauma. The guideline also recommends that doctors and their patients consider drug treatment to prevent fracture for men and women who are at risk of developing osteoporosis.

The authors did not find evidence to prove that one drug is definitively better than another medication. They recommend that physicians make individual treatment decisions based on the risks, benefits, and side effects profile of available drug options. However, there is good information that bisphosphonates are reasonable options for beginning drug treatment as they decrease the risk of vertebral, non-vertebral, and hip fractures.

"Because treatment options may affect various parts of skeletal system differently, we analyzed the available evidence on numerous drugs to prevent fractures in men and women," said Vincenza Snow, MD, FACP, a co-author of the guideline and director of clinical programs and quality of care at ACP. "Bisphosphonates can be considered a first-line therapy, particularly for patients at risk for hip fracture. However, there is no clear evidence showing the appropriate duration of treatment with these drugs."

A common side effect of bisphosphonates is upset stomach, but a rare and more serious risk involves breakdown of the jaw bone.

Among other available treatment options, the authors found that estrogen reduces the risk of vertebral, non-vertebral, and hip fractures, but can increase the risk of certain cancers, stroke, and blood clots. Studies show that drugs that work on estrogen receptors have no serious side effects and decrease spine fractures but not hip fractures.

They also found fair to good evidence that calcitonin and teriparatide reduce spine fractures but calcitonin does not reduce other types of fractures. Neither drug has serious side effects.

"The evidence on use of calcium, with or without vitamin D, is mixed and the effectiveness is modest," said Dr. Snow.

The "Pharmacologic Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women" guideline is based on a systematic evidence review of previously published studies. The review is available at www.annals.org/cgi/content/full/148/3/197.

In May 2008, ACP released a clinical practice guideline on screening for osteoporosis in men. The guideline calls for physicians to periodically assess the risk factors for osteoporosis in older men. Clinicians should obtain a DXA (dual-energy x-ray absorptiometry) scan for men who are at increased risk for osteoporosis and are candidates for drug therapy. ACP also recommends further research to evaluate osteoporosis screening tests in men.

ACP recommends that men and women talk to their internist about proper treatment for osteoporosis and low bone density.

About Osteoporosis and Low Bone Mass

Osteoporosis is a serious disease characterized by low bone mass and structural deterioration of bone tissue, leading to an increased risk of fractures of the hip, spine, and wrist. In addition to the estimated 44 million Americans with osteoporosis, an estimated 34 million Americans have low bone mass and are at an increased risk of developing the disease.

Risk Factors for Osteoporosis

Risk factors for osteoporosis in men are older age, low body weight, weight loss, physical inactivity, previous fractures not caused by substantial trauma, ongoing use of certain drugs (such as corticosteroids like prednisone or drugs that are sometimes used to treat prostate cancer), and low calcium diets. Risk factors for osteoporosis in women are lower body weight, weight loss, smoking, family history, decreased physical activity, alcohol or caffeine use, and low calcium and vitamin D intake.

Source: American College of Physicians