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Am Fam Physician. 2023;108(1):100-104

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Bisphosphonates, for up to five years orally or three years intravenously, are first-line therapy for osteoporosis.

• Denosumab injections every six months improve bone density more quickly than bisphosphonates, although bone density improvements fade within months after discontinuation unless bisphosphonates are started.

• Parathyroid hormone analog therapy for up to two years dramatically improves bone density and reduces fractures but requires subsequent bisphosphonate use to maintain benefit. 

• One year of treatment with romosozumab, a sclerostin-binding analog, followed by one year of alendronate reduces fracture risk more than two years of alendronate therapy alone.

From the AFP Editors

More than two-thirds of osteoporotic fractures occur in women, and one-half of postmenopausal women will experience an osteoporotic fracture. The American College of Obstetricians and Gynecologists (ACOG) has published new recommendations for managing this undertreated condition, including guidance on new medications and targeted treatments.

Health Inequities in Osteoporosis

Despite an increased risk of subsequent fracture within the first two years following a fracture, only one-fourth of women 60 years and older receive osteoporosis treatment during the first year. Black women are less likely than White women to receive treatment after diagnosis of osteoporosis, even after adjusting for insurance and socioeconomic status. Black women also have higher mortality in the year following a major fragility fracture.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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