In response to the new osteoporosis guidelines published by the American College of Physicians (ACP), the  American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) has issued a statement identifying the differences between the ACP guidelines and the 2016 AACE/ACE Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis – 2016 Update and Algorithm.

Five important differences were identified by AACE/ACE involving pharmacotherapy choice as well as treatment duration and reevaluation:

  • The recommendations in all AACE/ACE Guidelines reflect not only the latest evidence-based science, but also clinical experience and expert opinion, based upon the 2010 and 2014 AACE protocols for standardized production of clinical practice guidelines
  • Antiresorptive pharmacotherapy has demonstrated efficacy for fracture risk reduction, but there is also a significant role for anabolic therapy in the treatment of osteoporosis, particularly in patients with severe osteoporosis and those who have clinical fractures during antiresorptive use.
  • Duration of therapy needs to be individualized. The recommendation for 5 years of therapy may be appropriate for some, but not for other patients. Drug holidays are not recommended for those on denosumab since the protection from vertebral fracture may be lost within 3–18 months after discontinuation.
  • AACE/ACE guidelines recommend that after initiating therapy, patients should be reassessed with dual energy absorptiometry (DXA) bone mineral density (BMD) every 1 to 2 years until findings are stable, with continued interval monitoring depending on clinical circumstances. Thus, the frequency of BMD re-evaluation needs to be individualized. Obtaining a follow up DXA scan to identify individuals who are not responding to therapy is crucial to be able to change therapy before the occurrence of a clinical fracture that could be life altering.
  • Raloxifene is not recommended for use in the ACP guidelines. Although raloxifene is not effective in reducing hip fracture risk, the AACE/ACE guidelines indicate that it may be appropriate initial therapy in some women who require only spine-specific therapy. For women at high risk of spine fracture but not at risk for hip or nonvertebral fractures, raloxifene may be appropriate, especially when other antiresorptive drugs are not tolerated or contraindicated, and for patients seeking a potential additional “benefit” of reducing breast cancer risk.

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As mentioned in the American Society for Bone and Mineral Research (ASBMR) statement, AACE/ACE agrees that the ACP osteoporosis guidelines “fall short” in major components of osteoporosis management and treatment especially regarding the frequency of bone density monitoring, anabolic drug therapy, and treatment duration for antiresorptive agents. 

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