Vail senior care column: New guidelines governing osteoporosis care
If you or a loved one is at high risk of osteoporosis, then new guidelines from the American College of Physicians could affect the way you take care of your bones. The new recommendations update guidelines from 2008 and have been endorsed by the American Academy of Family Physicians.
The new guidelines include six recommendations, based on findings from medical research performed throughout the past decade. The American College of Physicians has classified two of these recommendations as strong recommendations based on the quality and extent of the research behind them.
Recommendations for care
Those two recommendations are:
• Doctors should use two types of medications (bisphosphonates and denosumab) as the first choice for preventing hip and vertebral fractures in women with or at risk for osteoporosis.
• Doctors should avoid any kind of hormone therapy as a treatment when combatting osteoporosis in women.
The first recommendation made by the new American College of Physicians guidelines covers the type of drugs that doctors should use to treat osteoporosis in women.
The guidelines recommend three types of medications classed as bisphosphonates (alendronate, risedronate and zoledronic acid) along with denosumab, a biologic agent. The American College of Physicians’ updated guidelines recommend that doctors prescribe one of these four types of medication as the first choice for osteoporosis treatment in women.
The recommendation also states that physicians should prescribe generic versions of these drugs whenever possible and that patients should be counseled on the risks of not taking these medications properly.
Rethink Hormone Therapy
The second strong recommendation made by the American College of Physicians is that doctors should no longer recommend hormone therapy as a treatment option for osteoporosis in women. The organization advised doctors to stop prescribing three common types of hormone therapy for osteoporosis: menopausal estrogen therapy, menopausal estrogen plus progestogen therapy and raloxifene.
This recommendation is based on new medical evidence that hormone therapy may not carry the benefits needed to make it an effective treatment.
Evidence also shows that hormone therapy comes with significant risks, such as cerebrovascular accidents and venous thromboembolism. These risks outweigh the potential benefits of this treatment, according to the American College of Physicians.
The American College of Physicians guidelines also included four further recommendations. These recommendations were classed as weak recommendations.
• Doctors should treat women with osteoporosis with medication-based treatment for five years, with treatment continuing after five years on a patient-by-patient basis.
• Doctors use the same medication treatment guidelines for men as they do for women.
• Doctors no longer include bone-density monitoring as part of osteoporosis treatment in women.
• Doctors base osteoporosis treatment decisions for senior-aged women on a discussion of patient preferences, fracture risk profile, benefits and harms and costs of medications.
These recommendations all received a weak recommendation classification due to lack of evidence or low-quality evidence.
While existing evidence suggests these recommendations may be beneficial for treatment, the American College of Physicians advises physicians to make treatment decisions based on their best judgment.
The updated American College of Physicians guidelines carry significant implications for seniors with or at risk of osteoporosis. If you or a loved one suffers from osteoporosis, then you may wish to speak directly with your physician about these new guidelines and whether or not they will impact your current treatment plan.
Anyone currently receiving hormone therapy for osteoporosis should speak with his or her physician about whether or not a change in treatment would be best.
Judson Haims is the owner of Visiting Angels Home Care in Eagle County. Contact him at 970-328-5526 or visit http://www.visitingangels.com/comtns.
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