| Abstract: |
Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis. LAY ABSTRACT Osteoporosis is preventable and treatable, but only a small proportion of those at increased risk for fracture are evaluated. This updated guideline provides recommendations based on scientific evidence to reduce the risk of osteoporosis-related fractures, and for health-care professionals to efficiently and effectively evaluate, diagnose, and treat osteoporosis in postmenopausal women, based on assessment of fracture risk, measurement of bone mineral density or bone mass, and a patient's history, presence and probability of fracture, among other factors. Several lifestyle modifications, such as adequate intake of calcium and vitamin D, regular exercise, a balanced diet, avoiding tobacco and limiting alcohol consumption, and removing potential risk factors to avoid falls, may improve balance, preserve bone strength, and prevent future fractures. All postmenopausal women aged 50 years and older should undergo clinical assessment for osteoporosis and fracture risk, using a fracture risk assessment tool when available. This update indicates numerous approved medications that could be used to reduce fractures and treat osteoporosis and for which appropriate groups of patients, depending on their level of risk factors. Decision-making regarding choice of medication can depend on fracture risk, location of fractures, benefits, cost, availability, patient preferences, and individual health history and circumstances. Based on the evidence and recommendations presented, physicians may determine when to initiate treatment, how to monitor response to therapy and identify those who have significant bone loss, and how to determine the success and duration of treatments for osteoporosis. |
