New updated ACP osteoporosis guidelines fall short in key areas

IOF supports the ASBMR assessment of the American College of Physicians updated osteoporosis guidelines, noting that the guidelines, although welcomed, omit new FDA approved anabolic therapies and do not sufficiently take into account patient variability.

The newly published clinical practice guidelines from the American College of Physicians (ACP) update the ACP’s 2008 recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women.1 The updated ACP guidelines, simplified to improve access by primary care physicians, emphasize the need for treatment to reduce the risk for hip and vertebral fractures in women who have osteoporosis. 

Given the current situation, in which many high-risk patients remain dangerously untreated, efforts to improve knowledge and assist clinical decision-making by primary care physicians are very much needed. In this respect the new ACP guidelines will be helpful and are very much welcomed by the bone health community.

However, as noted in a media statement issued by the American Society for Bone and Mineral Research (ASBMR) 2 , the guidelines fall short in three important areas:

Several of the guidelines may be too definitive in the face of absent or low-quality evidence and leave out important complexities and nuances that could help inform patient treatment decisions.
FDA-approved anabolic therapies, such as teriparatide and abaloparatide are omitted, although they are important treatment options for some patients, especially those with severe osteoporosis.
The guideline to discontinue osteoporosis medications after five years does not take into account individual variability for treatment as some patients may require more or less than five years of treatment. Some osteoporosis medications, such as denosumab, should not be discontinued without follow-up therapy, as doing so leads to negative clinical consequences.

IOF President Professor Cyrus Cooper stated:

Guidelines issued by US organisations such as the ACP are very influential internationally, and for that reason it is important that any concerns about, or omissions in, such new guidelines are communicated to physicians worldwide. As bone health experts, it’s our responsibility to ensure that primary care physicians – who play such a critical role in osteoporosis and fracture prevention – have accurate and complete information to ensure optimal patient care.”