American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Postmenopausal Osteoporosis

The American Association of Clinical Endocrinologists (AACE) published these guidelines on diagnosing and treating postmenopausal osteoporosis in 2010.  This summary will focus on the treatment recommendations given in the guidelines.

Bone Loss Prevention
In order to prevent bone loss, the following measures may be taken:

Nonpharmacologic Measures for Treating Osteoporosis
All of the above recommendations should be taken (for bone loss prevention).  Additionally, the following should be considered for treating postmenopausal osteoporosis:

Candidates for Pharmacologic Treatment
In these guidelines, the AACE endorses the 2008 National Osteoporosis Foundation Clinician’s Guide to Prevention and Treatment of Osteoporosis.  That publication recommends pharmacologic treatment for postmenopausal women who can be described by the following:

Pharmacologic Treatment Options for Osteoporosis
As first-line therapies, the guidelines suggest alendronate, risedronate, zoledronic acid, and denosumab.

As a second-line therapy, ibandronate is recommended.

Raloxifene can be considered as a second- or third-line therapy.

Calcitonin should be considered as a last-line therapy.

All of the above medications have proven anti-fracture efficacy.

The guidelines recommend against combination therapies.

Commentary by Pauline M. Camacho MD, FACE

The AACE Guidelines are one of the most comprehensive guidelines published in the past five years on the treatment of postmenopausal osteoporosis. It is the first guideline that has suggested the practice of initiating drug holidays for patients on long term bisphosphonate therapy. Readers may obtain a full copy of the guidelineon the AACE website.