The Endocrine Society released guidance (2019) on the pharmacological management of osteoporosis and, based on evidence, recommends
…treating postmenopausal women at high risk of fractures, especially those who have experienced a recent fracture, with pharmacological therapies, as the benefits outweigh the risks
Note: Osteonecrosis of the jaw (ONJ) and bisphosphonates: Absolute risk ranges from 1 in 10,000 to 1 in 100,000 | Higher risk in oncology setting | Risk may be as high as 21 in 10,000 if on medication >4 years | Increased risk with tooth extraction (0.5%)
Note: Tibolone may used based on the above clinical scenarios as well | Tibolone not currently available in the US or Canada)
Severe osteoporosis (i.e., low BMD T-score <−2.5 and fractures) or multiple vertebral fractures
Note: Women at high risk of cardiovascular disease (e.g., MI or stroke) should not be considered for romosozumab
FDA approves new treatment for osteoporosis in postmenopausal women at high risk of fracture
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