Pharmacological Management of Osteoporosis in Postmenopausal Women Guideline Resources

Full Guideline: Pharmacological Management of Osteoporosis in Postmenopausal Women
JCEM: May 2019 (online March 2019)

Richard Eastell, Clifford J. Rosen (chair), Dennis M. Black, Angela M. Cheung, M. Hassan Murad, and Dolores Shoback

The 2019 guideline on pharmacological management of osteoporosis in postmenopausal women:

  • Provides recommendations for the treatment and management of osteoporosis in postmenopausal women
  • Emphasizes assessment after being on treatments to see if further treatment is necessary

Systematic Reviews


Guideline Introduction | ENDO 2019

Essential Points

  • Treat high risk individuals - particularly those with previous fracture.
  • Consider bisphosphonates as the first line therapeutic choice for postmenopausal women at high risk of fracture.
  • Reassess fracture risk after patient has been on bisphosphonates for 3-5 years.
  • Following reassessment, prescribe a “bisphosphonate holiday” for women who are on bisphosphonates and are low-to-moderate risk of fracture.
  • Consider anabolic therapy (teriparatide or abaloparatide) for women at very high risk of fractures, including those with multiple fractures.
  • All women undergoing treatment with osteoporosis therapies other than anabolic therapy should consume calcium and vitamin D in their diet or via supplements.
  • Monitor the BMD of high-risk individuals with a low BMD every 1 to 3 years.

List of Recommendations

+ 1.0 Who to Treat

+ 2.0 Bisphosphonates

+ 3.0 Denosumab

+ 4.0 Teriparatide and Abaloparatide—Parathyroid Hormone and Parathyroid Hormone-Related Protein (PTHrP) Analogs

+ 5.0 Selective Estrogen Receptor Modulators

+ 6.0 Menopausal Hormone Therapy and Tibolone

+ 7.0 Calcitonin

+ 8.0 Calcium and Vitamin D

+ 11.0 Monitoring