The American College of Physicians’ new osteoporosis treatment guidelines support individualized medication plans, suggest an ideal length of therapy and take the clinical needs of seniors into account.
The guidance, last updated in 2017, highlights the role of bisphosphonates in preventing loss of bone density. Based on the latest clinical evidence, these drugs should be the initial pharmacologic treatment to reduce the risk of fractures in males and postmenopausal females diagnosed with primary osteoporosis, the authors advise.
The guideline authors compared the effectiveness of human parathyroid hormone-related peptides and sclerostin inhibitors. Bisphosphonates in postmenopausal females and males with primary osteoporosis strike the best balance between benefits, harms, patient values and preferences, and cost, they found.
Bisphosphonates include risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva), zoledronic acid (Reclast), and pamidronate (Aredia). Such medications are significantly less expensive than other pharmacologic treatments and can be prescribed as generic oral and injectable formulations, the authors wrote.
Stop prescription after five years
The new guidance also suggests that these therapies should typically be stopped after five years unless there are strong reasons to continue treatment. There is an increased risk of long-term harms when compared to effectiveness, the authors noted.
Polypharmacy should be a key consideration when treating adults aged 65 years and older with bone loss drugs, they added. Taking a large number of medications at once may leave seniors at risk for falls and other adverse events due to drug interactions.
Individualized treatment should address contraindications and cautions for osteoporosis drugs based on the patient’s comorbidities and other medications. Older patients’ medications should also be reviewed to check for other drugs linked to falls and fracture risk.
The full guidelines can be accessed in the Annals of Internal Medicine.
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