Prevention of Osteoporosis and Osteoporotic Fractures in Postmenopausal Women (2002)

Home Guidelines (1979-2006) Prevention of Osteoporosis and Osteoporotic Fractures in Postmenopausal Women (2002)

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RECOMMENDATIONS

  • The CTFPHC concludes that there is fair evidence to screen postmenopausal women to prevent fragility fractures. (B Recommendation)
  • For those who screen positive for osteoporosis, there is fair evidence to recommend using alendronate, risedronate, or raloxifene to treat. There is fair evidence to recommend using etidronate, oral pamidronate, and limited duration of parathyroid hormone (PTH) for women with severe osteoporosis. If none of these drugs are tolerated, hormone replacement therapy (HRT) or calcitonin can be considered. There is fair evidence to recommend using history of previous fracture for the prediction of osteoporotic fractures. (B Recommendation)
  • There is good evidence to recommend using SCORE or ORAI to predict low BMD. (A Recommendation)
  • There is fair evidence to recommend screening using BMD to predict fractures. (B Recommendation)
  • There is insufficient evidence to recommend using bone turnover markers to predict fractures in individual postmenopausal woman. (I Recommendation)
  • In women without documented osteoporosis, there is fair evidence to recommend calcium and vitamin D. (B Recommendation)
  • There is fair evidence that HRT prevents total fractures in this population, however, risks may outweigh benefits. (B Recommendation)
  • There is insufficient evidence to recommend for or against exercise, raloxifene, bisphosphonates, calcitonin, parathyroid hormone, fluoride or combination therapy to prevent osteoporotic fractures in this population. (I Recommendation)
  • For postmenopausal women with osteoporosis but no prevalent fractures, there is good evidence to recommend alendronate (A Recommendation) and fair evidence to recommend risedronate or raloxifene (B Recommendation) for the secondary prevention of vertebral fractures. (A Recommendation, B Recommendation)
  • There is fair evidence to recommend alendronate or risedronate for secondary prevention of hip and nonvertebral fractures. (B Recommendations)
  • All postmenopausal women are recommended to have adequate calcium and vitamin D, since participants in these clinical trials were all supplemented with calcium and vitamin D. There is insufficient evidence to recommend for or against calcium and vitamin D alone, HRT, exercise, calcitonin, parathyroid hormone, fluoride or combination therapy to prevent fractures in this population. (I Recommendation)
  • For postmenopausal women with osteoporosis and prevalent fractures there is good evidence to recommend alendronate (A Recommendation) and fair evidence to recommend raloxifene, risedronate, etidronate, or oral pamidronate (all B Recommendations) for the tertiary prevention of vertebral fractures. (A Recommendation, B Recommendations)
  • There is fair evidence to recommend alendronate for the prevention of hip fractures, and risedronate for the prevention of hip and nonvertebral fractures. (B Recommendation)
  • There is fair evidence to support the use of PTH for the prevention of vertebral and non-vertebral fractures, however its long-term safety is unclear. (B Recommendation)
  • There is insufficient evidence to recommend for or against exercise, HRT, calcitonin, fluoride or combination therapy to prevent osteoporotic fractures in this population. (I Recommendation)