ACP recommends that physicians offer drug treatment to men and women who have been diagnosed with osteoporosis or a previous fracture not caused by substantial trauma. The guideline also recommends that doctors and their patients consider drug treatment to prevent fracture for men and women who are at risk of developing osteoporosis.
The authors did not find evidence to prove that one drug is definitively better than another medication. They recommend that physicians make individual treatment decisions based on the risks, benefits, and side effects profile of available drug options. However, there is good information that bisphosphonates are reasonable options for beginning drug treatment as they decrease the risk of vertebral, non-vertebral, and hip fractures.
"Because treatment options may affect various parts of skeletal system differently, we analyzed the available evidence on numerous drugs to prevent fractures in men and women," said Vincenza Snow, MD, FACP, a co-author of the guideline and director of clinical programs and quality of care at ACP. "Bisphosphonates can be considered a first-line therapy, particularly for patients at risk for hip fracture. However, there is no clear evidence showing the appropriate duration of treatment with these drugs."
A common side effect of bisphosphonates is upset stomach, but a rare and more serious risk involves breakdown of the jaw bone.
Among other available treatment options, the authors found that estrogen reduces the risk of vertebral, non-vertebral, and hip fractures, but can increase the risk of certain cancers, stroke, and blood clots. Studies show that drugs that work on estrogen receptors have no serious side effects and decrease spine fractures but not hip fractures.
In May 2008, ACP released a clinical practice guideline on screening for osteoporosis in men. The guideline calls for physicians to periodically assess the risk factors for osteoporosis in older men. Clinicians should obtain a DXA (dual-energy x-ray absorptiometry) scan for men who are at increased risk for osteoporosis and are candidates for drug therapy. ACP also recommends further research to evaluate osteoporosis screening tests in men.
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