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Osteoporosis Treatment Guideline with verbatims
Embargoed for release until 5:00 p.m. Eastern Time on Mon., May 8, 2017
Embargoed for release until 5:00 p.m. Eastern Time on Mon., May 8, 2017
(1) Announcer: Take a generic bisphosphonate but
skip the DEXA scan during treatment for osteoporosis,
the American College of Physicians recommends in an
evidence-based guideline published in Annals of
Internal Medicine.
Jack Ende,
MD, MACP, president, ACP
(2) Dr. Jack Ende: Physicians should treat women
with osteoporosis with either the bisphosphonates,
which include alendronate, risedronate, and zoledronic
acid. Or, there’s now a new agent available,
denosumab, which is a monoclonal antibody, a newer
biologic agent.
(3) Announcer. An estimated 54 million men and
women in the United States have low bone density or
osteoporosis. ACP’s guideline recommends five years
of treatment during which bone density monitoring is
not recommended.
(4) Dr. Jack Ende: The ACP guideline recommends
that DEXA scans need not be done during the five year
course of treatment. The information shows that a
DEXA scan preformed while a patient is receiving
treatment, such as a bisphosphonate, really does not
alter therapy.
(5) Announcer: ACP also recommends against using
menopausal estrogen therapy or menopausal estrogen
plus progestin therapy or raloxifene for treatment.
(6) Dr. Jack Ende: In the case of estrogen treatment
for osteoporosis, in fact the harms outweigh the
benefits. The harms include increased risk of
cardiovascular disease. It’s been associated with
breast cancer, and also with deep venous thrombosis.
(7) Announcer: Medication adherence is an important
part of treatment because patients with osteoporosis
often do not feel any symptoms while taking medicine.
(8) Dr. Jack Ende: As a general rule, physicians
should prescribe generic drugs. That’s important as a
Osteoporosis Treatment Guideline with verbatims
Embargoed for release until 5:00 p.m. Eastern Time on Mon., May 8, 2017
way to keep costs down and to improve adherence,
because cost is certainly a part of adherence.
(9) Announcer: For men with osteoporosis, ACP
recommends that physicians offer drug treatment with
bisphosphonates to reduce the risk for vertebral
fracture.
(10) Dr. Jack Ende: Men with osteoporosis should be
treated. The data do show reduction in vertebral
fractures when treatment is provided, and we believe
that with more data we’ll be able to demonstrate that
there’ll be reduction in non-vertebral fractures as well.
(11) Announcer: The American Academy of Family
Physicians has endorsed ACP’s guideline. For more
information go to acponline.org.
Separate soundbites that the media can also download Dr. Jack Ende
Calcium and vitamin D supplements are important for the management of osteoporosis.
Likewise, exercise is important. However, by themselves, calcium and vitamin D supplement
and exercise are not effective in treating either osteopenia or osteoporosis.
Adherence is very important for osteoporosis. It’s a disease without symptoms. And the
treatment for it is long term, typically years. Our standard would be five years. And for that
reason there has to be a careful and well-thought out discussion [00:07:41;00] between the
physician and the patient, and adherence is one of the major issues that should be part of that
discussion.
The evidence does not support frequent monitoring of women with normal bone mineral
density. If bone mineral density is normal, the likelihood of that woman going on to develop
osteoporosis and a vertebral or fragility fracture is very low. For that reason, repeated DEXA
scan is not recommended.
For female patients over age 65, whose bone mineral density shows osteopenia, not
osteoporosis—that is they have abnormally low bone mineral density, but not at the range that
would qualify for osteoporosis—in that case, the decision about whether or not to treat should
be made jointly by the physician and the patient.
Courtesy the American College of Physicians, publisher of Annals of Internal Medicine.
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