➤ 6.2 In postmenopausal women with osteoporosis at high risk of fracture
and with the patient characteristics below, ES suggests tibolone to prevent
vertebral and nonvertebral fractures. (2|⊕⊕⊕
)
• Patient Characteristics:
▶ Under 60 years of age or <10 years past menopause
▶ With a 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 or high risk for cardiovascular
disease
▶ Without breast cancer
▶ Willing to take tibolone
Technical Remark:
▶ Tibolone is not available in the U.S. or Canada.
Calcitonin
➤ 7.1 In postmenopausal women at high risk of fracture with osteoporosis,
ES suggests that nasal spray calcitonin be prescribed only in women who
cannot tolerate raloxifene, bisphosphonates, estrogen, denosumab, tibolone,
abaloparatide, or teriparatide or for whom these therapies are not considered
appropriate. (2|⊕
)
Calcium and Vitamin D
➤ 8.1 In postmenopausal women with low BMD and at high risk of fractures with
osteoporosis, ES suggests that calcium and vitamin D be used as an adjunct
to osteoporosis therapies. (2|⊕⊕
)
➤ 8.2 In postmenopausal women at high risk of fracture with osteoporosis
who cannot tolerate bisphosphonates, estrogen, selective estrogen response
modulators, denosumab, tibolone, teriparatide, and abaloparatide, ES
recommends daily calcium and vitamin D supplementation to prevent hip
fractures. (1|⊕⊕⊕
)
Monitoring
➤ 9.1 In postmenopausal women with a low BMD and at high risk of fractures
who are being treated for osteoporosis, ES suggests monitoring the BMD
by DXA at the spine and hip every 1 to 3 years to assess the response to
treatment. (2|⊕
)
Technical Remark:
▶ Monitoring BTMs (serum CTX for antiresorptive therapy or P1NP for bone anabolic
therapy) is an alternative way of identifying poor response or nonadherence to therapy.
