AHRQ Publishes New Guide on Osteoporosis Fracture Prevention Treatments

According to the Agency for Healthcare Research and Quality, or AHRQ, osteoporosis affects older individuals of both genders but is more common in postmenopausal women. About 1.5 million people each year in the United States suffer an osteoporosis-related fracture. Of those who experience hip fractures, one in five dies, and the same number ends up in a nursing home within one year of the fracture.

Now, a new publication from AHRQ offers clinicians guidance on the effectiveness and safety of various treatments for preventing fractures in postmenopausal women with osteoporosis.

Fracture Prevention Treatments for Postmenopausal Women with Osteoporosis reviews a wide range of treatments, such as bisphosphonates, selective estrogen receptor modulators, hormonal medications, calcium and vitamin D. It also outlines dosage and pricing information for these products.

In its "Clinical Bottom Line" section, the guide briefly recaps the relative effectiveness of these products, offering a "level of confidence" rating for their efficacy in preventing specific types of fractures. For example, the guide says with a high level of confidence that some bisphosphonates and estrogen prevent hip and other nonvertebral fractures, whereas raloxifene, estrogen, teriparatide and most bisphosphonates prevent vertebral fractures.

The guide then analyzes various treatment approaches and gives suggestions on possible nonmedical treatments to improve bone health, including changes to diet and adherence to an exercise regimen. It also gives recommendations for daily intake of calcium and vitamin D.

Also included in the guide is information to consider when selecting a treatment approach. One key component of the selection process is possible barriers to adherence, including mode of administration, dosing regimens and cost. For example, weekly users of bisphosphonates have higher rates of adherence than daily users. The guide also advises physicians to consider the risk of adverse events. For example, it recommends avoiding the use of bisphosphonates in women with a history of serious gastrointestinal disease and avoiding zoledronic acid in women who are at high risk for atrial fibrillation.

The possible adverse effects of the various treatments are covered in some detail. Side effects of some of the drugs used to prevent osteoporotic fractures can include gastrointestinal difficulties (e.g., acid reflux, nausea, vomiting, heartburn, ulcers, bleeding), atrial fibrillation, musculoskeletal pain and osteonecrosis of the jaw.

In addition, the guide contains an entire section on hormonal medications, with a special focus on their possible side effects. These include stroke, breast cancer and other breast problems, gynecologic issues, and osteosarcoma.