➤ Treat high risk individuals - particularly those with previous fracture.
➤ Consider bisphosphonates as the first line therapeutic choice for
postmenopausal women at high risk of fracture.
➤ Reassess fracture risk after patient has been on bisphosphonates for 3-5 years.
➤ Following reassessment, prescribe a "bisphosphonate holiday" for women who
are on bisphosphonates and are low-to-moderate risk of fracture.
➤ Consider anabolic therapy (teriparatide or abaloparatide) for women at very
high risk of fractures, including those with multiple fractures.
➤ All women undergoing treatment with osteoporosis therapies other than
anabolic therapy should consume calcium and vitamin D in their diet or via
supplements.
➤ Monitor the BMD of high-risk individuals with a low BMD every 1 to 3 years.
Key Points
Treatment and Management
Who to Treat
➤ 1.1 Endocrine Society (ES) recommends treating postmenopausal women at high
risk of fractures, especially those who have experienced a recent fracture, with
pharmacological therapies, as the benefits outweigh the risks. (1|⊕⊕⊕⊕)
Bisphosphonates
➤ 2.1 In postmenopausal women at high risk of fractures, ES recommends initial
treatment with bisphosphonates (alendronate, risedronate, zoledronic acid, and
ibandronate) to reduce fracture risk. (1|⊕⊕⊕⊕)
Technical Remark:
▶ Ibandronate is not recommended to reduce nonvertebral or hip fracture risk.
