Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patients
    • Disease patterns
    • Diagnostics
    • Therapy
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Allergology and clinical immunology
    • General Internal Medicine
    • Anesthesiology
    • Angiology
    • Surgery
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Nutrition
    • Gastroenterology and Hepatology
    • Genetics
    • Geriatrics
    • Gynecology
    • Hematology
    • Infectiology
    • Cardiology
    • Nephrology
    • Neurology
    • Emergency and intensive care medicine
    • Nuclear Medicine
    • Oncology
    • Ophthalmology
    • ORL
    • Orthopedics
    • Pediatrics
    • Pharmacology and toxicology
    • Pharmaceutical medicine
    • Phlebology
    • Physical medicine and rehabilitation
    • Pneumology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • Radiology
    • Forensic Medicine
    • Rheumatology
    • Sports Medicine
    • Traumatology and trauma surgery
    • Tropical and travel medicine
    • Urology
    • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
  • Log In
  • Register
  • My account
  • Contact
  • English
    • Deutsch
    • Français
    • Italiano
    • Português
    • Español
  • Publications
  • Contact
  • Deutsch
  • English
  • Français
  • Italiano
  • Português
  • Español
Subscribe
Medizinonline Medizinonline
Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patienten
    • Krankheitsbilder
    • Diagnostik
    • Therapie
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Fachbereiche 1-13
      • Allergology and clinical immunology
      • General Internal Medicine
      • Anesthesiology
      • Angiology
      • Surgery
      • Dermatology and venereology
      • Endocrinology and Diabetology
      • Nutrition
      • Gastroenterology and Hepatology
      • Genetics
      • Geriatrics
      • Gynecology
      • Hematology
    • Fachbereiche 14-26
      • Infectiology
      • Cardiology
      • Nephrology
      • Neurology
      • Emergency and intensive care medicine
      • Nuclear Medicine
      • Oncology
      • Ophthalmology
      • ORL
      • Orthopedics
      • Pediatrics
      • Pharmacology and toxicology
      • Pharmaceutical medicine
    • Fachbereiche 26-38
      • Phlebology
      • Physical medicine and rehabilitation
      • Phytotherapy
      • Pneumology
      • Prevention and health care
      • Psychiatry and psychotherapy
      • Radiology
      • Forensic Medicine
      • Rheumatology
      • Sports Medicine
      • Traumatology and trauma surgery
      • Tropical and travel medicine
      • Urology
      • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
Login

Sie haben noch keinen Account? Registrieren

  • Osteoporosis treatment according to needs

What’s new?

    • Congress Reports
    • General Internal Medicine
    • Gynecology
    • Orthopedics
    • Rheumatology
    • RX
    • Studies
  • 3 minute read

The American College of Physicians (ACP) published an updated 2023 guideline on drug therapy for patients with reduced bone density or osteoporosis. An extensive secondary analysis published last year has been incorporated as the evidence base. A bottom line of the new ACP guidelines is that the place of bisphosphonates as first-line therapy has been strengthened.

Primary osteoporosis is characterized by a loss of bone mass and density leading to an increased risk of fracture, particularly of the hip and spine [1]. According to the WHO classification, a T-score of -1.0 to -2.5 is osteopenia and -2.50 or below is osteoporosis [2]. The T-score represents the standard deviation of bone density compared to 20-29 year old individuals of the same sex. Fractures can occur in any part of the body, but hip and spine fractures account for 42% of all osteoporotic fractures [3]. The 2023 secondary analysis by Ayers et al. published in the Annals of Internal Medicine. on which the updated American College of Physicians (ACP) recommendations for the treatment of osteoporosis are based, included 34 randomized controlled trials (RCTs) and 36 observational studies [3,4].

Value of bisphosphonates as first-line therapy underpinned

The new ACP guidelines recommend bisphosphonates as first-line therapy for postmenopausal women and for men with primary osteoporosis-with the exception of women at very high risk of fracture [3,4]. In this group, the osteoanabolic substances romosozumab (sclerostin inhibitor) or teriparatide (recombinant parathyroid hormone) can be used initially for 1 or 2 years, respectively, followed by bisphosphonate therapy to prevent renewed bone mass loss. The use of denosumab is advocated as second-line therapy for men and women with contraindications (or side effects) to bisphosphonates. Similar to the 2017 guideline version, the ACP suggests prescribing bisphosphonates in women over 65 years of age with low bone mass/osteopenia, depending on their risk profile, as part of an individualized treatment approach.

Treatment effects in postmenopausal women with osteoporosis.

Most of the 34 RCTs and 36 observational studies that served as the evidence base for the ACP guidelines in the secondary analysis included data on postmenopausal women with osteoporosis [4]. The following are the main results for this patient population (Table 1, Table 2) .

Risk of hip fracture: Compared with placebo, bisphosphonates reduced the risk of hip fracture by 65% over a 24-month period and by 64% over a 36-48-month period. Denosumab therapy for 36 months reduced hip fracture risk by 61%. In women at very high risk of fracture based on age and history, sequential treatment with romosozumab followed by alendronate proved more effective in reducing hip fracture risk than alendronate alone with respect to a 24-month period (RR 0.62; CI 0.42-0.91].

Clinical spine fractures: treatment with bisphosphonates for 12 to 36 months and 36 months of denosumab therapy reduced the risk of clinical spine fractures by 54-68% compared with placebo. Teriparatide was associated with a 76% risk reduction at 17 months, and romosozumab reduced risk by 82% at 12 months. The only treatment option that proved more effective than bisphosphonates in reducing the risk of clinical spine fractures was sequential treatment with romosozumab followed by alendronate for 24 months.

Other fractures: Over a period of 12 to 36 months, all treatment options except denosumab showed a reduction in the risk of other clinical fractures in the placebo comparison. With respect to 36 months or more, bisphosphonates and denosumab reduced the risk of clinical fractures, but bazedoxifene and raloxifene did not. In women at very high risk of fracture, sequential treatment with romosozumab followed by alendronate proved more effective than alendronate alone (RR 0.74; CI 0.63-0.89), and teriparatide showed greater efficacy than risedronate at 24 months (RR 0.64; CI 0.43-0.95]. Regarding abaloparatide (18 months; RR 0.35 [KI 0,15–0,81]) and raloxifene (12 months; RR 0.17 [KI 0,03–0,81]), there were moderate effects. In a 19-month head-to-head RCT, abaloparatide was found to be more effective in reducing clinical fractures compared with teriparatide (RR 0.43 [KI 0,21–0,90].

Congress: Practice Update

Literature:

  1. Fassnacht M: Thyroid gland. Endocrinology, Manual, Practice Update, Berlin, April 28-29, 2023.
  2. Kanis JA; on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007. Accessed at www.sheffield.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf on 20 July 2022, (last accessed 10 Jun 2023).
  3. Qaseem A., et al: Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians. Ann Intern Med 2023; 176(2): 224-238.
  4. Ayers C, et al: Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Metaanalysis for the American College of Physicians. Ann Intern Med 2023; 176(2): 182-195.

HAUSARZT PRAXIS 2023; 18(6): 22–23

Autoren
  • Mirjam Peter, M.Sc.
Publikation
  • HAUSARZT PRAXIS
Related Topics
  • ACP
  • Alendronate
  • American College of Physicians
  • Ayers
  • Bisphosphonates
  • Bone density
  • Denosumab
  • Fracture
  • Guideline
  • medicinal
  • Osteoporosis
  • Practice Update
  • Risedronate
  • Secondary analysis
  • Therapy
  • Treatment
  • Zoledronate
Previous Article
  • Malnutrition in old age

A problem underestimated for a long time

  • RX
  • CME continuing education
  • Gastroenterology and Hepatology
  • General Internal Medicine
  • Geriatrics
  • Neurology
  • Nutrition
  • Studies
View Post
Next Article
  • Disease of the subcutaneous adipose tissue

Lipedema – a painful fatty tissue disease of the extremities in women.

  • CME continuing education
  • Dermatology and venereology
  • General Internal Medicine
  • Physical medicine and rehabilitation
  • RX
  • Studies
  • Surgery
  • Unkategorisiert
View Post
You May Also Like
View Post
  • 4 min
  • Case Report

Mycosis fungoides in an 11-year-old child

    • Allergology and clinical immunology
    • Cases
    • Dermatology and venereology
    • Education
    • Oncology
    • Pediatrics
    • RX
    • Studies
View Post
  • 6 min
  • EHA 2025

Progress in multiple myeloma

    • Congress Reports
    • Hematology
    • Oncology
    • RX
    • Studies
View Post
  • 6 min
  • Interstitial lung diseases

Artificial intelligence improves ILD diagnosis

    • Education
    • General Internal Medicine
    • Pneumology
    • Prevention and health care
    • RX
    • Studies
View Post
  • 7 min
  • Management of patients after alloHCST

ERS/EBMT guideline recommendations on pulmonary cGvHD

    • Education
    • General Internal Medicine
    • Genetics
    • Hematology
    • Pneumology
    • RX
    • Studies
View Post
  • 3 min
  • Pyoderma gangraenosum

New study data confirm the validity of the PARACELSUS score

    • Congress Reports
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Geriatrics
    • Orthopedics
    • Prevention and health care
    • RX
    • Studies
    • Surgery
View Post
  • 8 min
  • Progressive multiple sclerosis

New horizons: from BTK inhibitors to remyelination

    • Education
    • Genetics
    • Neurology
    • RX
    • Studies
View Post
  • 6 min
  • Cutaneous and especially facial metastases

Rare manifestations of esophageal carcinoma

    • Cases
    • Dermatology and venereology
    • Education
    • Gastroenterology and Hepatology
    • Oncology
    • RX
    • Surgery
View Post
  • 7 min
  • Rare pulmonary syndromes

Yellow nail and Swyer-James syndrome

    • CME continuing education
    • Dermatology and venereology
    • General Internal Medicine
    • Infectiology
    • Pneumology
    • RX
Top Partner Content
  • Herpes zoster

    Zum Thema
Top CME content
  • 1
    Colorectal cancer screening – an update
  • 2
    Yellow nail and Swyer-James syndrome
  • 3
    Individual therapy management for an optimized outcome – an update
  • 4
    Doing sport without fear or risk
  • 5
    UV protection and skin cancer screening – Update 2025

Newsletter

Sign up and stay up to date

Subscribe
Medizinonline
  • Contact
  • General terms and conditions
  • Imprint

Input your search keywords and press Enter.