An Endocrine Society Guideline Update for Pharmacological Ma
An Endocrine Society Clinical Practice released Guideline for the pharmacological management of osteoporosis in postmenopausal women using romosozumab. This Guideline Update is published in response to the recent approval of romosozumab by the US FDA, the European Medicines Agency, Health Canada and other agencies, and it represents a formal amendment to the Endocrine Society’s recently published clinical practice guideline regarding the pharmacological management of postmenopausal osteoporosis

The guidelines has discussed the efficacy of Romosozumab, a monoclonal antibody targeting sclerostin, for the prevention of fractures and concluded that this agent can be considered a treatment option for postmenopausal women at very high risk for osteoporotic fracture.

Key recommendations:

1. Who to Treat
We recommend treating postmenopausal women at high risk of fractures, especially those who have experienced a recent fracture, with pharmacological therapies, as the benefits outweigh the risks.

2. Bisphosphonates
In postmenopausal women at high risk of fractures, we recommend initial treatment with bisphosphonates (Alendronate, Risedronate, Zoledronic acid, and Ibandronate) to reduce fracture risk.

3. Romosozumab (UPDATE 2020)

a. In postmenopausal women with osteoporosis at very high risk of fracture, such as those with severe osteoporosis (ie, low T-score less than−2.5 and fractures) or multiple vertebral fractures, we recommend romosozumab treatment for up to 1 year for the reduction of vertebral, hip, and nonvertebral fractures.
Technical remark: The recommended dosage is 210 mg monthly by subcutaneous injection for 12 months. Women at high risk of cardiovascular disease and stroke should not be considered for romosozumab pending further studies on cardiovascular risk associated with this treatment. High risk includes prior myocardial infarction or stroke.

b. In postmenopausal women with osteoporosis who have completed a course of romosozumab, we recommend treatment with antiresorptive osteoporosis therapies to maintain bone mineral density gains and reduce fracture risk.

4. Teriparatide and Abaloparatide (Parathyroid Hormone and Parathyroid Hormone-Related Protein Analogs)

5. Selective Estrogen Receptor Modulators
In postmenopausal women with osteoporosis at high risk of fracture and with the patient characteristics[With a low risk of deep vein thrombosis and for whom bisphosphonates or denosumab are not appropriate or with a high risk of breast cancer.], we recommend raloxifene or bazedoxifene to reduce the risk of vertebral fractures.   

6. Menopausal Hormone Therapy and Tibolone
In postmenopausal women at high risk of fracture and with the patient characteristics [under 60 years of age or less than 10 years past menopause; at low risk of deep vein thrombosis; those in whom bisphosphonates or denosumab are not appropriate; with bothersome vasomotor symptoms; with additional climacteric symptoms], we suggest menopausal hormone therapy, using estrogen-only therapy in women with hysterectomy, to prevent all types of fractures.

7. Calcium and Vitamin D
In postmenopausal women with low bone mineral density and at high risk of fractures with osteoporosis, we suggest that calcium and vitamin D be used as an adjunct to osteoporosis therapies

Click on the link to view the Updated algorithm for management of postmenopausal osteoporosis

Find the detailed guidelines here:

About the society:
Endocrine Society is a global community of physicians and scientists dedicated to accelerating scientific breakthroughs and improving patient health and well being.

Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.
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