Osteoporosis Treatment Guideline with Verbatims
Osteoporosis Treatment Guideline with verbatims
Embargoed for release until 5:00 p.m. Eastern Time on Mon., May 8, 2017
Embargoed for release until 5:00 p.m. Eastern Time on Mon., May 8, 2017
(1) Announcer: Take a generic bisphosphonate but skip the DEXA scan during treatment for osteoporosis, the American College of Physicians recommends in an evidence-based guideline published in Annals of Internal Medicine.Jack Ende,
MD, MACP, president, ACP / (2) Dr. Jack Ende: [00:02:29;06]Physicians should treat women with osteoporosis with either the bisphosphonates, which include alendronate, risedronate, and zoledronic acid. Or, there’s now a new agent available, denosumab, which is a monoclonal antibody, a newer biologic agent.
(3) Announcer. An estimated 54 million men and women in the United States have low bone density or osteoporosis. ACP’s guideline recommends five years of treatment during which bone density monitoring is not recommended.
(4) Dr. Jack Ende: The ACP guideline recommends that DEXA scans need not be done during the five year course of treatment. The information shows that a DEXA scan preformed while a patient is receiving treatment, such as a bisphosphonate, really does not alter therapy.
(5) Announcer: ACP also recommends against using menopausal estrogen therapy or menopausal estrogen plus progestin therapy or raloxifene for treatment.
(6) Dr. Jack Ende: In the case of estrogen treatment for osteoporosis, in fact the harms outweigh the benefits. The harms include increased risk of cardiovascular disease. It’s been associated with breast cancer, and also with deep venous thrombosis.
(7) Announcer: Medication adherence is an important part of treatment because patients with osteoporosis often do not feel any symptoms while taking medicine.
(8) Dr. Jack Ende: As a general rule, physicians should prescribe generic drugs. That’s important as a way to keep costs down and to improve adherence, because cost is certainly a part of adherence.
(9) Announcer: For men with osteoporosis, ACP recommends that physicians offer drug treatment with bisphosphonates to reduce the risk for vertebral fracture.
(10) Dr. Jack Ende: Men with osteoporosis should be treated. The data do show reduction in vertebral fractures when treatment is provided, and we believe that with more data we’ll be able to demonstrate that there’ll be reduction in non-vertebral fractures as well.
(11) Announcer: The American Academy of Family Physicians has endorsed ACP’s guideline. For more information go to acponline.org.
Separate soundbites that the media can also download Dr. Jack Ende
Calcium and vitamin D supplements are important for the management of osteoporosis. Likewise, exercise is important. However, by themselves, calcium and vitamin D supplement and exercise are not effective in treating either osteopenia or osteoporosis.
Adherence is very important for osteoporosis. It’s a disease without symptoms. And the treatment for it is long term, typically years. Our standard would be five years. And for that reason there has to be a careful and well-thought out discussion [00:07:41;00] between the physician and the patient, and adherence is one of the major issues that should be part of that discussion.
The evidence does not support frequent monitoring of women with normal bone mineral density. If bone mineral density is normal, the likelihood of that woman going on to develop osteoporosis and a vertebral or fragility fracture is very low. For that reason, repeated DEXA scan is not recommended.
For female patients over age 65, whose bone mineral density shows osteopenia, not osteoporosis—that is they have abnormally low bone mineral density, but not at the range that would qualify for osteoporosis—in that case, the decision about whether or not to treat should be made jointly by the physician and the patient.
Courtesy the American College of Physicians, publisher of Annals of Internal Medicine.
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