Osteoporosis Guidelines Issued
Bone Health Counseling Begins in Adolescence
August 21, 2012
Washington, DC – An estimated $17 billion is spent each year to treat the roughly 2 million osteoporosis-related bone fractures that occur in the US annually, according to practice guidelines issued today by The American College of Obstetricians and Gynecologists (The College). The College’s updated guidelines address the prevention, screening, diagnosis, and treatment of osteoporosis, as well changes to recommended calcium and vitamin D levels for women.
Osteoporosis is five times more prevalent among women than among men. Women have twice the fracture rate of men, and 80% of hip fractures occur among elderly women, primarily because women outlive men in the US. The College recommends that ob-gyns address bone health with all of their patients, beginning at puberty and adolescence when girls are at their peak bone-building stage. Women should be counseled about lifestyle factors that may affect bone density and fracture risk, including smoking, poor nutrition, excessive weight loss, weight-bearing and muscle-strengthening exercise, and fall prevention measures.
Dual-energy X-ray absorptiometry (DXA) of the lumbar spine and hip is the gold standard for diagnosing osteoporosis, and bone mineral density (BMD) screening should begin at age 65 for all women. Postmenopausal women younger than 65 should only be screened with DXA if they have significant risk factors for osteoporosis and/or bone fracture. As an addition to screening, FRAX, a fracture risk assessment tool, can help to further predict a person’s risk of bone fracture in the next 10 years. It can be used to determine if a patient is at high risk for fracture if her initial scan indicates low bone mass. FRAX is based on risk factors such as age, body mass index, history of fracture, daily alcohol intake, and whether or not a patient smokes, has rheumatoid arthritis, or has any other secondary causes of osteoporosis. In the absence of new risk factors, DXA screening should not be performed more frequently than every two years. FRAX should be used on an annual basis to monitor the effect of age on fracture risk.
The Institute of Medicine (IOM) recommends 1,300 IU (international units) of daily calcium for girls ages 9–18; 1,000 IU per day for women ages 19–50; and 1,200 IU per day for women over age 50. The IOM recently increased the recommended dietary allowance of vitamin D from 200 to 400 IU to 600 IU per day for most people, and from 600 IU to 800 IU per day after age 70. The College says that, aside from high-risk individuals, routine screening of vitamin D levels is not recommended.
There are many medications for treatment of osteoporosis, including bisphosphonates, partial estrogen agonists and antagonists, denosumab, calcitonin, and parathyroid hormone. The document released today includes an updated list of all FDA-approved drugs for the treatment of osteoporosis.
Practice Bulletin #129 “Osteoporosis” is published in the September issue of Obstetrics & Gynecology.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org