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ESOST01204a
Disclaimer
is pocket guide attempts to define principles of practice that should produce high-quality patient care. It focuses
on the needs of primary care practice, but also is applicable to providers at all levels. is pocket guide should not
be considered exclusive of other methods of care reasonably directed at obtaining the same results. e ultimate
judgment concerning the propriety of any course of conduct must be made by the clinician aer consideration of each
individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service
associated with the distributor of this clinical reference tool.
Source
Eastell R, Rosen CJ (chair), Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological Management
of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin
Endocrinol Metab 2019; 104(5):1595-1622
Shoback D, Rosen CJ (chair), Black DM, Cheung AM, Murad MH, Eastell R. Pharmacological Management
of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update. J Clin Endocrinol Metab
2020; doi: 10.1210/clinem/dgaa048
Abbreviations
BMD, bone mineral density; CTX, C-terminal crosslinking telopeptide; DVT, deep venous thrombosis; DXA,
dual-energ y X-ray absorptiometry; ES, Endocrine Society; HT, hormone therapy; IV, intravenously; P1NP,
procollagen type 1 N-terminal propeptide; PTH, parathyroid hormone; RCT, randomized control trial; SERM,
selective estrogen response modulator; VTE, venous thromboembolism
Grading System
Quality of Evidence
High Quality Moderate Quality Low Quality Very Low Quality
Description of Evidence • Well-performed
RCTs
• Very strong evidence
from unbiased
observational
studies
• RCTs with some
limitations
• Strong evidence
from unbiased
observational
studies
• RCTs with
serious flaws
• Some
evidence from
observational
studies
• Unsystematic
clinical
observations
• Very indirect
evidence from
observational
studies
Strength of Recommendation
Strong (1):
"ES recommends…"
Benefits clearly outweigh
harms and burdens or
vice versa
1|⊕⊕⊕⊕
1|⊕⊕⊕
1|⊕⊕
1|⊕
Conditional (2):
"ES suggests…"
Benefits closely balanced
with harms and burdens
2|⊕⊕⊕⊕
2|⊕⊕⊕
2|⊕⊕
2|⊕
Ungraded Good
Practice Statement
UGPS
