New Osteoporosis Medicine Recommendations By ASBMR


If you have osteoporosis, you should be getting treated. If you have low bone mass, or risk for osteoporosis you can consider diet, exercise and what physicians call "watchful waiting." In the days when women took estrogen, mostly for other reasons, they were also protected from hip fractures. Now with women stopping estrogen, a large study published in Menopause at the end of 2011, it shows that just discontinuing your medication lead to a 55% greater risk of hip fractures. If you look at what the bone mass did, for women on estrogen who had normal to low scores, about 2 years out the average patient had slipped into osteoporosis. But when you think about treating your bones with other medications, we also have to think about the long term consequences of those medications. The most common is to get a prescription of bisphosphonate. In looking over the over 300 reports of odd fractures in users of bisphosphonates a task force of ASBMR, a bone research group, had come out with a set of recommendations in early 2011, most of which as of 2012, considered the standards you can discuss with your gyno, they are as listed here:
  1. Restrict the long-term use of potent antiresorptive agents to patients with osteoporosis or high fracture risk, and avoid their use in patients with low bone mass (osteopenia) without other risk factors who are at low risk of fracture.
  2. Do not combine bisphosphonates or denosumab with estrogens or estrogen agonist/antagonists (formerly known as SERMs) without documentation of inadequate response to estrogens or estrogen or estrogen agonist/antagonists.
  3. Be prepared to explain to patients who are candidates for bisphosphonate therapy that the likelihood of having a hip or spine fracture is much greater if they do NOT take therapy than is the risk of having an atpical fracture on treatment, especially during the first 5 years.
  4. Similarly, encourage high-risk patients NOT to discontinue bisphosphonate therapy on the basis of the media coverage of atypical fractures, for the fracture-protective effect of therapy disappears upon stopping treatment, just as it does when estrogen therapy is withdrawn.
  5. At annual follow-up visits, reevaluate the justification for bisphosphonate therapy and remind those continuing treatment to report the occurrence of thigh pain so that affected patients can be identified and managed before frank femoral fracture occurs
It is important to remember these bone and osteoporosis treatment guidelines are very technical in nature and may not apply exactly to your case. It is also important to discuss what your current as well as longer term strategy should be if you fall into these categories. Find out how stopping or starting estrogen treatment might affect these guidelines, it is also individual. Over the past 2-3 years women have been getting therapy if they qualify for medication based of high fracture risk. For most women this is a combination of risk factors that you and your physician can go over. For those wanting to understand their own risks I encourage them to look up the WHO recommended FRAX score. Like some patients who are uniquely at risk for other individual diseases, there may be genetic issues that make some people at risk for developing problems on these medications. It is important to remember that in women, estrogen protects our bones, in a natural and healthy way, prior to menopause, and may in fact still be a healthy way to protect ones bones as you transition through the menopause and beyond. Gynos have not reported atypical osteoporosis fractures with estrogen treatment for osteoporosis, so that might be reason for some women to at least consider continuing estrogen therapy if they have been on it. Currently estrogen has not been the standard of care for treatment of osteoporosis and if you were once on estrogen, the effects on your bones wears off in 12-18 months and only testing can determine the current health of your bones. For women perplexed regarding their current treatments we feel that it is important to consider all factors: your overall health, your balance, your exercise level, your tobacco and alcohol intake as well as other medical issues when speaking to your gyno about bone health.

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