AACE/ACE Guidelines
American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis — 2016--Executive Summary

https://doi.org/10.4158/EP161435.ESGLGet rights and content

ABSTRACT

Abbreviations:

AACE = American Association of Clinical Endocrinologists

AFF = atypical femur fracture

ASBMR = American Society for Bone and Mineral Research

BEL = best evidence level

BMD = bone mineral density

BTM = bone turnover marker

CBC = complete blood count

CI = confidence interval

DXA = dual-energy X-ray absorptiometry

EL = evidence level

FDA = U.S. Food and Drug Administration

FLEX = Fracture Intervention Trial (FIT) Long-term Extension

FRAX® = Fracture Risk Assessment Tool

GFR = glomerular filtration rate

GI = gastrointestinal

HORIZON = Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly

IOF = International Osteoporosis Foundation

ISCD = International Society for Clinical Densitometry

IU = international units

IV = intravenous

LSC = least significant change

NBHA = National Bone Health Alliance

NOF = National Osteoporosis Foundation

25(OH)D = 25-hydroxy vitamin D

ONJ = osteonecrosis of the jaw

PINP = serum carboxy-terminal propeptide of type I collagen

PTH = parathyroid hormone

R = recommendation

RANK = receptor activator of nuclear factor kappa-B

RANKL = receptor activator of nuclear factor kappa-B ligand

RCT = randomized controlled trial

RR = relative risk

S-CTX = serum C-terminal telopeptide

SQ = subcutaneous

VFA = vertebral fracture assessment

WHO = World Health Organization

Section snippets

1. Introduction

Osteoporosis is a growing major public health problem with impacts on quality and quantity of life that cross medical, social, and economic lines. These guidelines were developed by the American Association of Clinical Endocrinologists (AACE) with hopes of reducing the risk of osteoporosis-related fractures and thereby maintaining the quality of life for people with osteoporosis. The guidelines use the best evidence, taking into consideration the economic impact of the disease and the need for

2. Methods for Development of AACE Clinical Practice Guidelines for Postmenopausal Osteoporosis

Evidence was obtained through MEDLINE searches and other designated reference sources. Expert opinion was used to evaluate the available literature and to grade references relative to evidence level (EL) (Table 1), evidence analysis, and subjective factors (Table 2), based on the ratings of 1 through 4 from the 2010 and 2014 AACE protocols for standardized production of clinical practice guidelines (available online at https://www.aace.com/files/checklists_july_2014_ep.pdf) (1 [EL 4; CPG NE], 2

3. Executive Summary

To guide readers, recommendations are organized into the following questions:

  • Q1. How is fracture risk assessed and osteoporosis diagnosed?

  • Q2. When osteoporosis is diagnosed, what is an appropriate evaluation?

  • Q3. What are the fundamental measures for bone health?

  • Q4. Who needs pharmacologic therapy?

  • Q5. What medication should be used to treat osteoporosis?

  • Q6. How is treatment monitored?

  • Q7. What is successful treatment of osteoporosis?

  • Q8. How long should patients be treated?

  • Q9. Is combination

Co-Chairs

Dr. Pauline Camacho reports that she has received research grant support from Amgen Inc, and NPS Pharmaceuticals.

Dr. Steven M. Petak reports that he has received consulting fees from NASA-JSC.

Task Force Members

Dr. Neil Binkley reports that he has received advisory/consultant honoraria from Merck, Amgen, Eli Lilly and Company, Bristol-Myers Squibb, and Nestle. He has also received research support from Amgen, Merck, Eli Lilly and Company, Opko Health, Novartis, and GE Healthcare Lunar.

Dr. Bart Clarke reports that

ACKNOWLEDGMENTS

Reviewers of the AACE/ACE Postmenopausal Osteoporosis Clinical Practice Guidelines: Robert Adler, MD; Donald A. Bergman, MD, MACE; John Paul Bilezikian, MD, MACE; Dima L. Diab, MD, FACE, CCD; Angelo Licata, MD, PhD, FACP, FACE; Alan Malabanan MD, FACE, CCD; Michael R. McClung, MD.

REFERENCES (3)

There are more references available in the full text version of this article.

Cited by (0)

The American Association of Clinical Endocrinologists/American College of Endocrinology Medical Guidelines for Practice are systematically developed statements to assist healthcare professionals in medical decision-making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.

These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances.

A complete list of the Reviewers of the AACE/ACE Postmenopausal Osteoporosis Clinical Practice Guidelines can be found in the Acknowledgments.

View full text