Ann Intern Med. Published online May 8, 2017.

Guideline Highlights

•        The recommendation authors focused on research published between 2005 and 2011.

•        First-line treatments to treat osteoporosis include alendronate, risedronate, zoledronic acid, and denosumab. All of these treatments have good evidence in reducing the risks for vertebral, hip, and nonvertebral fractures.

•        Ibandronate is not as recommended because of insufficient data regarding its effects on the risk for hip fracture.

•        Bisphosphonates are associated with a risk for atypical subtrochanteric fractures, which appears to increase substantially when treatment extends past 5 years. New evidence suggests that bisphosphonates do not promote atrial fibrillation.

•        Denosumab is associated with an increased risk for infection, although this risk may not pertain to serious infection. Both denosumab and bisphosphonates are associated with a small increase in the risk for osteonecrosis of the jaw.

•        Raloxifene does not appear to reduce the risk for nonvertebral or hip fracture. The relatively new combination of bazedoxifene with estrogen lacks data on fracture prevention.

•        Estrogen treatment can improve BMD during treatment but does not prevent fracture among women with established osteoporosis. The authors specifically recommend against the use of estrogen and raloxifene in the treatment of osteoporosis.

•        The effect of calcium and vitamin D on the risk for fracture is uncertain, as is the effect of physical activity.

•        The treatment period for osteoporosis should be 5 years, but continuation of treatment past 5 years may be considered after shared decision making regarding the risks and benefits associated with therapy.

•        BMD monitoring during treatment has generally not been associated with improved outcomes. Therefore, such testing is unnecessary during the 5-year treatment period.

•        Despite a low level of evidence, the authors recommend treatment with bisphosphonates among men with recognized osteoporosis in order to prevent vertebral fracture.

資料來源：PubMedAmerican College of Physicians