Osteoporosis is often a silent
disease and is responsible for minimal trauma fractures in the hip, spine and
ribs later in life.
In contrast to senile
osteoporosis, osteoporosis occurs much more in the spine in postmenopausal
osteoporosis, which is a cancellous bone. In senile osteoporosis, bones
are 50-50, cancellous as well as cortical. Osteoporosis occurs both in
the spine and hip. The commonest fractures in osteoporosis are spine fractures
in postmenopausal women followed by fractures in hip and wrist.
The Endocrine Society has
published new clinical practice guidelines on the management of osteoporosis in
postmenopausal women. The guidelines were presented at ENDO 2019, its annual
meeting in New Orleans, La.
Some key recommendations from
the guidelines include:
· Postmenopausal
women at high risk of fractures, especially those who have experienced a recent
fracture, should receive pharmacological therapies, as the benefits outweigh
the risks.
· Initial
treatment with bisphosphonates to reduce fracture risk.
· Reassess
fracture risk after 3-5 years in women taking bisphosphonates.
· Women
who remain at high risk of fractures should continue therapy, while those who
are at low-to-moderate risk of fractures should be considered for a
“bisphosphonate holiday.”
· Using
denosumab as an alternative to bisphosphonates for the initial treatment of
high-risk individuals.
· Daily
calcium and vitamin D supplementation for postmenopausal women at high risk of
fracture with osteoporosis who cannot tolerate bisphosphonates, estrogen,
selective estrogen response modulators (SERMs), denosumab, tibolone, teriparatide
and abaloparatide.
· Monitor
bone mineral density by DEXA spine and hip in postmenopausal women with a low
bone mineral density and at high risk of fractures every 1 to 3 years to
evaluate response to treatment.
(Source: Endocrine Society News
Release, March 25, 2019; J Clin Endocrinol Metab. May 2019;104(5)
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
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