August 31, 2017
Updated Guidelines for Prevention and Treatment of Glucocorticoid-Induced Osteoporosis: The American College of Rheumatology (ACR) updated its previous 2010 recommendations for preventing and treating glucocorticoid-induced osteoporosis (GIOP). An expert panel performed a systematic review involving patients taking systemic glucocorticoids (prednisone >2.5 mg/day) for ≥3 months. The guidelines address initial assessment and reassessment of patients starting or continuing glucocorticoid treatment and the relative benefits and risks of lifestyle changes and use of calcium, vitamin D, bisphosphonates, raloxifene, teriparatide, and denosumab in adults and select special populations.
June 2, 2017
Abaloparatide for Treatment of High-Risk Postmenopausal Osteoporosis: Abaloparatide (TymlosTM) is a synthetic analog of human parathyroid hormone (PTH) related peptide acting as an anabolic agent to stimulate bone formation. It is FDA-approved for treatment of postmenopausal women with osteoporosis at high risk for fracture (defined as multiple risk factors for fracture or a history of osteoporotic fracture) or patients who have failed or are intolerant to other therapies. The Phase 3 controlled ACTIVE Trial demonstrated reduced new vertebral and nonvertebral fractures and increased bone mineral density after 18 months with abaloparatide compared with placebo. There are no controlled trials comparing abaloparatide with teriparatide or other agents. When abaloparatide is discontinued, antiresorptive treatment should be considered as sequential therapy to protect against bone loss.
CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
For the chapter in the Wells Handbook, please go to Chapter 3. Osteoporosis.
Osteoporosis is a public health epidemic that affects all ages, genders, races, and ethnicities. Lifestyle behaviors, diseases, and medications should be reviewed to identify risk factors for developing osteoporosis and osteoporotic fractures. Healthcare providers should identify and resolve reversible risks. Patients with early onset or severe osteoporosis should be evaluated for secondary causes of bone loss.
Bone physiology and pathophysiology are complex, involving many different cell lines, pathways, and biofeedback systems. As these processes become more delineated, additional drug targets exist creating new investigational agents.
Ten-year probabilities for a major osteoporotic and hip fracture can be estimated for women (postmenopausal to age 90 years old) and men (50-90 years old) with the FRAX tool. This tool is a questionnaire that can be used in any setting, including a pharmacy, health fair, or clinic. Central bone densitometry can determine bone mass, predict fracture risk, and influence patient and provider treatment decisions.
Throughout life, everyone should practice a bone healthy lifestyle, which emphasizes regular exercise, nutritious diet, tobacco avoidance, minimal alcohol use, and fall prevention to prevent and treat osteoporosis.
Treatment should be considered for postmenopausal women and men older than 50 years who have a low-trauma hip or vertebral fracture, T-score of –2.5 or less at the femoral neck, total hip, or spine or low bone mass (T-score between –1.0 and –2.5) and a FRAX 10-year probability of major osteoporotic fracture of 20% or ...