New osteoporosis guideline says start with a bisphosphonate



Clinical considerations in addition to drug types

The new guideline also advises:

  • Clinicians treating adults with osteoporosis should encourage adherence to recommended treatments and healthy lifestyle habits, including exercise, and counseling to evaluate and prevent falls.
  • All adults with osteopenia or osteoporosis should have adequate calcium and vitamin D intake, as part of fracture prevention.
  • Clinicians should assess baseline fracture risk based on bone density, fracture history, fracture risk factors, and response to prior osteoporosis treatments.
  • Current evidence suggests that more than 3-5 years of bisphosphonate therapy reduces risk for new vertebral but not other fractures; however, it also increases risk for long-term harms. Therefore, clinicians should consider stopping bisphosphonate treatment after 5 years unless the patient has a strong indication for treatment continuation.
  • The decision for a bisphosphonate holiday (temporary discontinuation) and its duration should be based on baseline fracture risk, medication half-life in bone, and benefits and harms.
  • Women treated with an anabolic agent who discontinue it should be offered an antiresorptive agent to preserve gains and because of serious risk for rebound and multiple vertebral fractures.
  • Adults older than 65 years with osteoporosis may be at increased risk for falls or other adverse events because of drug interactions.
  • Transgender persons have variable risk for low bone mass.

The review and guideline were funded by the ACP. Dr. Ott has reported no relevant disclosures. Relevant financial disclosures for other authors are listed with the guideline and review.

A version of this article first appeared on


Recommended Reading

Total replacement and fusion yield similar outcomes for ankle osteoarthritis
MDedge Rheumatology
Prednisone, colchicine equivalent in efficacy for CPP crystal arthritis
MDedge Rheumatology
Sarilumab effective for polymyalgia rheumatica in phase 3 trial
MDedge Rheumatology
Mind the geriatrician gap
MDedge Rheumatology
Corticosteroid injections may worsen knee OA progression
MDedge Rheumatology