Latest update since 2010 incorporates latest findings on risk assessment, prevention, and treatment

The North American Menopause Society (NAMS) has updated its position statement to reflect current findings and the latest approaches to the management of osteoporosis in postmenopausal women. The statement is published in Menopause: The Journal of The North American Menopause Society.

Last updated in 2010 and entitled, the statement now includes the risk factors and risk-assessment tools to help clinicians identify candidates for pharmacologic treatment, as well as clarifying the recommended intakes of calcium, vitamin D, and protein necessary to maintain bone health.

Michael R. McClung, MD, NAMS board member, and co-lead of the 2021 Osteoporosis Position Statement Editorial Panel, spoke with BreakingMED about the need for the update.

“Since the last Position Statement in 2010, there have been many new developments in our field including delineation of additional risk factors for fracture, resulting in better strategies for assessing fracture risk; much more information about the long-term safety of anti-remodeling therapies, the availability of three new drugs, each with a unique mechanism of action, for treating osteoporosis; and clinical experience informing us of the effects of using different treatments in various sequences. Additionally, there are no new drugs in the clinical development pipeline, so our therapeutic choices will not change for several years, making it timely to provide a summary of current treatment options and strategies,” he said.

Some of the more important highlights from this 2021 position statement include the following:

  • The primary cause of bone loss leading to osteoporosis at menopause is estrogen deficiency.
  • Osteoporosis is progressive with advancing age, even when optimal preventive measures are followed, including proper nutrition and regular physical activity.
  • Nearly 50% of women aged 50 years will experience an osteoporosis-related fracture during their lifetime. These fractures can often cause significant symptom burden and have deleterious effects on function and quality of life.
  • Once a diagnosis of osteoporosis has been made, life-long management is required.
  • The most appropriate treatment to prevent bone loss at the time of menopause for healthy women is hormone therapy, and this is especially true for women who experience menopausal symptoms.
  • Bone mineral density as measured during treatment is directly correlated with patient hip fracture risk, and hip T-scores are the appropriate clinical targets upon which clinicians should base therapeutic choices.
  • Most patients with osteoporosis are treated with anti-remodeling drugs including bisphosphonates and denosumab, but the most recent recommendation for those at very high fracture risk focuses on treatment initiation with an osteoanabolic or bone-building agent, followed by an anti-remodeling agent.

Of particular significance, said McClung, is the conclusion that “General measures such as good nutrition and regular physical activity are important and useful but are not sufficient to treat patients with osteoporosis.”

It is also important to note that the statement also specifies that estrogen therapy has an important role in preventing osteoporosis in young postmenopausal women. Finally, he stressed, clinicians must be aware that the strongest risk factor for another fracture in postmenopausal women is a recent fracture.

“Having a fracture should be thought of and assessed as a ’bone attack,’” he told BreakingMED.

Since 2010, the FDA has granted approval to one new drug for osteoporosis prevention (conjugated estrogen plus basedoxifene [Duavee]), and to three new drugs for treatment, which include denosumab (Prolia), abaloparatide (Tymlos), and romosozumab (Evenity).

“We have very effective tools to identify patients in need of treatment as well as multiple treatment options that are effective and safe, including drugs that rebuild bone structure,” said McClung.

In counseling patients, McClung recommended that physicians stress the following: “Osteoporosis can be effectively and safety treated, but long-term if not life-long management is required to reduce the risk of fractures.”

“Because osteoporosis is so common among postmenopausal women (affecting at least half of women over age 50), all physicians and nurse practitioners caring for postmenopausal women should be knowledgeable about the prevention and treatment of osteoporosis, and we hope that the comments in the updated NAMS Position Statement will aid them in that endeavor,” concluded McClung.

  1. A new updated position statement from the North American Menopause Society includes recommendations and strategies focused on minimizing bone loss in postmenopausal women.

  2. The update now includes the risk factors and risk-assessment tools to help clinicians identify candidates for pharmacologic treatment, and clarifies the recommended intakes of calcium, vitamin D, and protein necessary to maintain bone health.

Liz Meszaros, Deputy Managing Editor, BreakingMED™

Coauthor Cosman reports Consultant/Advisory Board for Amgen, EnteraBio, and Obseva, and Speakers’ Bureau for Amgen and Radius Health. Coauthor Lewiecki reports Consultant/Advisory Board for Amgen and Radius, and Speakers’ Bureau for Radius. Coauthor McClung reports Consultant/Advisory Board for Amgen, and Speakers’ Bureau for Amgen and Alexion. Coauthor Shapiro reports Consultant/Advisory Board for Amgen, Aspen, Astellas, Bayer, BioSyent, Duchesnay, GSK, Merck, Mithra, Pfizer, Searchlight, Sprout, Sunovion, and TherapeuticsMD.

Cat ID: 191

Topic ID: 83,191,494,438,730,191,334,142,192,255,925,481,96