ACP Releases Guidance Update on Osteoporosis Treatment
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. List the medications to use to treat women with osteoperosis 2. Restate the clinical risk factors for osteoperosis
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
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For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
The ACP has released an update on treatment of osteoporosis. Bone mass and changes in bone microarchitecture leads to bone fragility and risk of fracture. Osteoporosis is common, with 50% of individuals over 50 years of age at risk of fracture and can result in substantial morbidity and mortality. While osteoporosis can occur in both men and women, and the update covers all individuals, female sex is a known risk factor. The AAFP has endorsed these recommendations.
SUMMARY OF RECOMMENDATIONS FOR WOMEN:
Treat women with known osteoporosis to reduce hip and vertebral fractures with the following medications (Grade: strong recommendation; high-quality evidence)
Treat osteoporotic women for 5 years (Grade: weak recommendation; low-quality evidence)
Do not monitor bone density during 5 year treatment period
Do not use menopausal estrogen therapy (with or without progestogen) or raloxifene (Grade: strong recommendation; moderate-quality evidence)
≥ age 65 at high risk for osteopenic fractures (Grade: weak recommendation; low-quality evidence)
Base treatment on informed decision making risks and benefits
NOTE – RECOMMENDATIONS FOR MEN:
Bisphosphonates to reduce the risk for vertebral fracture in setting of clinical diagnosis of osteoporosis (Grade: weak recommendation; low-quality evidence)
RISK FACTORS FOR OSTEOPEROSIS (Partial List):
Premature ovarian failure
Family or personal history of fractures due to osteoporosis
Medications (partial list)
Gonadotropin-releasing hormone agonists
vitamin D deficiency
low calcium intake
Low bone mineral density (BMD)
Alcohol intake (3 or more drinks daily)
Occurrence of fragility fracture
Dual-energy x-ray absorptiometry (DXA)
Will only predict less than 50% of fractures
FRAX (the World Health Organization Fracture Risk Assessment Tool) combines clinical factors with BMD testing results
T score of –2 indicates a BMD that is 2 SDs below the comparative norm
International reference standard in postmenopausal women and in men aged 50 years or older
Neck BMD of 2.5 SD or more < the young female adult mean
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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