American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis— 2020 Update Executive Summary

Abstract

Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis.

Osteoporosis and Osteoporotic Fracture Fact Sheet in Korea

“…[18] Moreover, patients with osteopenia with clinical risk factors of fractures are now regarded to be as deserving of treatment as patients with osteoporosis. [4,19,20] However, no recommendation has been issued regarding the treatment of patients with osteopenia in Korea and AOMs such as SERMs and BPs are not currently cov-ered by health insurance in this patient population.…”

“…[1] Societal aging unavoidably increases the incidences of osteoporosis and related fractures, which are associated with enormous medical, social, and economic burdens. [2][3][4] In recent Korea, the socioeconomic burdens of osteoporosis have increased and mortalities after osteoporosis-related fractures have become higher than those in the general population. [5,6] Nevertheless, the need to diagnose and actively treat osteoporosis has not received great concerns in Korea, presumably because the disease is asymptomatic before a fracture occurs.…”

Retrospective analysis of the use of osteoporosis medication at the presentation of fragility fractures in a predominantly Hispanic population

“…It is possible that patients might have been diagnosed at a primary care facility not associated with our hospital system; thus, documentation of DXA scans or diagnosis is not within our system's electronic medical record. However, it should be noted that in the midnineties, the use of bone mineral density scans for osteoporosis was not recommended [27], but this view has been challenged, and DXA remains the "gold standard" for osteoporosis diagnosis [28,29]. An additional possibility to consider is that the patients initiate the reported use of calcium and vitamin D on their own, as part of a multi-vitamin regime, or only as a physician's recommendation due to their advanced age.…”

“…However, the presence of a fragility fracture is one of the critical factors for the diagnosis of osteoporosis [31]. Based on the new practice guidelines for endocrinologists, the current patient population would fall on the very high-risk group based on the presence of a fracture within the previous 12 months [29]. Despite the limitations, the current study sets the stage for designing prospective interventions in high-risk groups for osteoporotic fractures.…”

Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

“…Inclusion criteria: Meeting the diagnostic criteria of osteoporosis [7] ; OVCF caused by acute or subacute non-signi cant external force; Only one vertebral fracture; Follow-up for more than 12 months with complete follow-up data; No obvious trauma history during follow-up; Underwent PVA treatments; No complications related to PVA, such as pulmonary embolism.…”