AACE/ACE Guidelines Released for Postmenopausal Osteoporosis Assessment, Treatment

The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) recently published new guidelines regarding the diagnosis, evaluation, and treatment of postmenopausal osteoporosis (Endocr Pract. 2016;22[suppl 4]:1-42). 

These recommendations are based on evaluations of current, evidence-based literature and graded references based on the 2010 and 2014 AACE protocols for standardized production of clinical practice guidelines.

First author and president elect of AACE, Pauline Camacho, MD, FACE, and colleagues suggest that all postmenopausal women (aged ≥ 50) should receive clinical assessment for osteoporosis and fracture risk. Bone mineral density testing is also recommended in women aged ≥ 65 and in those women at increased risk based on fracture risk analysis.

Further, due to the high prevalence of secondary osteoporosis, medical evaluation is indicated in all women with postmenopausal osteoporosis and at high fracture risk in order to identify coexisting medical conditions that may be contributing to the patient’s bone loss.

With regard to pharmacologic therapy, patients with lower or moderate fracture risk can be started on oral agents while injectable agents can be considered as initial therapy for those who have the highest fracture risk. The AACE does not recommend combination therapy for osteoporosis prevention or treatment until more research has been done to fully understand its effects.

Researchers note that the published guidelines are a working document that reflects the current state of the field at this point in time. Medical professionals are encouraged to use the guide in conjunction with their “best clinical judgement,” as the “recommendations may not be appropriate in all situations.”—Amanda Del Signore