Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians
An erratum to this article was published (Ann Intern Med, Jun 2023 ↗)
Methodological detailsliving guideline, based on updated systematic review, GRADE
- Living guideline
- Based on updated systematic review
- GRADE
Recommendations
As issued by the authors
- strong recommendation; high-certainty evidence
1A: Use bisphosphonates for initial pharmacologic treatment to reduce fracture risk in postmenopausal females with primary osteoporosis
- conditional recommendation; low-certainty evidence
1B: Use bisphosphonates for initial pharmacologic treatment to reduce fracture risk in males with primary osteoporosis
- conditional recommendation; moderate-certainty evidence
2A: Use RANK ligand inhibitor (denosumab) as second-line treatment to reduce fracture risk in postmenopausal females with primary osteoporosis who have contraindications to or adverse effects of bisphosphonates
- conditional recommendation; low-certainty evidence
2B: Use RANK ligand inhibitor (denosumab) as second-line treatment to reduce fracture risk in males with primary osteoporosis who have contraindications to or adverse effects of bisphosphonates
- conditional recommendation
3: Use sclerostin inhibitor (romosozumab, moderate-certainty evidence) or recombinant PTH (teriparatide, low-certainty evidence), followed by a bisphosphonate, to reduce fracture risk only in females with primary osteoporosis at very high fracture risk
- conditional recommendation; low-certainty evidence
4: Individualized approach to whether to start a bisphosphonate in females over 65 with low bone mass (osteopenia) to reduce fracture risk
Original publication
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