(HealthDay News) — In a clinical practice guideline update published online May 9 in the Annals of Internal Medicine, recommendations are presented for the treatment of low bone density and osteoporosis to prevent fractures.

Amir Qaseem, M.D., Ph.D., from the American College of Physicians in Philadelphia, and colleagues conducted a systematic review of the literature to update the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures. They focused on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density.

The authors developed six recommendations for the target patient population of men and women with low bone density and osteoporosis. For women with known osteoporosis, the ACP recommends that clinicians offer alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures. Osteoporotic women should be treated with pharmacologic therapy for five years; during the treatment period, the ACP recommends against bone density monitoring. For men who have clinically recognized osteoporosis, clinicians should offer pharmacologic treatment with bisphosphonates to reduce vertebral fracture risk.

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In addition, for women with osteoporosis, the ACP recommends against menopausal estrogen therapy or menopausal estrogen plus progesterone therapy or raloxifene. For osteopenic women aged 65 years or older, clinicians should made the decision to provide treatment after discussion of patient preferences; fracture risk profile; and benefits, harms, and costs of medications.

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