Come gestire l’osteoporosi in post-menopausa?

The Endocrine Society USA has published new guidelines. They emphasize increased screening, greater focus on prevention, and particular attention to pharmacological treatment. Which treatment is the most effective?

1. BISPHOSPHONATES: First-line treatment for postmenopausal osteoporosis.

2. Patients with MILD-MODERATE fracture risk, after 3–5 years, should consider the possibility of a "drug holiday," meaning a temporary suspension of therapy. The beneficial effects of bisphosphonates are evident even after discontinuation (RESIDUAL EFFECT). For other drug classes, the benefits are lost immediately after therapy is stopped!

3. MANDIBULAR OSTEONECROSIS: A rare event that occurs only with high doses of bisphosphonates (injectables used in cancer treatment). Currently, major U.S. dental associations have differing recommendations regarding BSF therapy: for instance, the ADA (American Dental Association) generally does not recommend discontinuing BSF treatment in conjunction with dental procedures, while the AAOMS (American Association of Oral and Maxillofacial Surgeons) suggests a drug holiday for a period of 2 months in patients who have been on BSF therapy for more than 4 years.  

Bibliography

Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1-28.