Clinical Practice Guideline

Treatment of Low Bone Density or Osteoporosis

(Endorsed, April 2017)

The guideline, Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women, was developed by the American College of Physicians and was endorsed by the American Academy of Family Physicians.

Key Recommendations

Pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab should be prescribed for women with osteoporosis to reduce the risk of hip and vertebral fractures.
Pharmacologic treatment should continue for five years, during which time bone density monitoring should not be done.
Menopausal estrogen therapy, menopausal estrogen plus progesterone, or raloxifene should not be used in women with osteoporosis.
The decision to treat women 65 years of age or older who have osteopenia and are at a high risk for fracture should be based on a discussion of patient preferences, fracture risk profile, benefits and harms of treatment, and costs of medications.
Treatment with bisphosphonates should be offered to men who have osteoporosis to reduce the risk of vertebral fractures.

More About Practice Guidelines

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.