Treatment and Management
➤ 4.2 In postmenopausal women with osteoporosis who have completed a course
of teriparatide or abaloparatide, ES recommends treatment with antiresorptive
osteoporosis therapies to maintain bone density gains. (1|⊕⊕
)
Romosozumab
➤ A.1 In postmenopausal women with osteoporosis at very high risk of fracture,
such as those with severe osteoporosis (i.e., low T-score <-2.5 and fractures)
or multiple vertebral fractures, we recommend romosozumab treatment for
up to one year for the reduction of vertebral, hip, and nonvertebral fractures.
(1|⊕⊕⊕
)
Technical Remarks
▶ The recommended dosage is 210 mg monthly by subcutaneous injection for 12 months.
▶ Women at high risk of cardiovascular disease and stroke should not be considered for
romosozumab pending further studies on cardiovascular risk associated with this
treatment. High risk includes prior myocardial infarction or stroke.
➤ A.2 In postmenopausal women with osteoporosis who have completed a course
of romosozumab, we recommend treatment with antiresorptive osteoporosis
therapies to maintain bone mineral density gains and reduce fracture risk.
(1|⊕⊕⊕
)
Selective Estrogen Receptor Modulators
➤ 5.1 In postmenopausal women with osteoporosis at high risk of fracture
and with the patient characteristics below, ES recommends raloxifene or
bazedoxifene to reduce the risk of vertebral fractures. (1|⊕⊕⊕⊕)
• Patient Characteristics:
▶ with a low risk of DVT, and
▶ for whom bisphosphonates or denosumab are not appropriate, or
▶ with a high risk of breast cancer
Menopausal Hormone Therapy and Tibolone
➤ 6.1 In postmenopausal women at high risk of fracture and with the patient
characteristics below, ES suggests menopausal HT, using estrogen only in
women with hysterectomy, to prevent all types of fractures. (2|⊕⊕⊕
)
• Patient Characteristics:
▶ Under 60 years of age or <10 years past menopause
▶ At low risk of DVT
▶ Those in whom bisphosphonates or denosumab are not appropriate
▶ With bothersome vasomotor symptoms
▶ With additional climacteric symptoms
▶ Without contraindications
▶ Without prior myocardial infarction or stroke
▶ Without breast cancer
▶ Willing to take menopausal HT
