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Understanding New Endocrine Society Guidelines for Treating Osteoporosis

Many bone experts are concerned that doctors haven’t been aggressive enough lately in treating osteoporosis.

Research presented in 2017 by the American Society for Bone and Mineral Research found that, after a steady drop in the rate of hip fractures over a number of years, the rate has now leveled off in the U.S. The ASBMR was so concerned that it issued a “Call to Action to Address the Crisis in the Treatment of Osteoporosis.”

Another article published in 2018 in the journal Osteoporosis International found that hip fracture rates were higher than predicted in 2013-15. The authors called this a “remarkable change” and suggested further study of the cause.

In response to such alarming trends, two physician groups – the Endocrine Society and the American College of Physicians – recently issued new guidelines for treatment and management of osteoporosis. The two sets of guidelines have some significant differences, but taken together, along with the ASBMR’s call to action, they provide a blueprint for doctors to follow when they work with patients who have osteoporosis to prevent fractures.


New guidelines issued by the Endocrine Society encourage doctors to be more aggressive in treating osteoporosis.

Here are some of the guidelines issued in spring 2019 by the Endocrine Society:

  • Women who have reached menopause should have their 10-year fracture risk factors
  • Women who are at risk for osteoporosis or have had a low-impact fracture should get a bone density test.
  • All postmenopausal women need information about physical activity and nutrition that help support healthy bones, including optimal levels of calcium and vitamin D.
  • Patients at high risk need advice about medicines to strengthen their bones, including bisphosphonates or denosumab as the first choice for treatment. Patients with very high risk for fractures should consider medicines that build bone with medicines like teriparatide and abaloparatide, or romosozumab-aqqq.  
  • Women who have been on the osteoporosis medicines called bisphosphonates for 3 to 5 years should get a repeat bone density test and fracture risk assessment. Women who have a low-to-moderate risk of fracture should be prescribed a “bisphosphonate holiday.”
  • All women taking osteoporosis medicines — except anabolics — should consume 3-4 servings of a calcium-rich food and vitamin D or by taking supplements.
  • Patients at high risk should get a bone density test every 1 to 3 years.
  • Postmenopausal women taking denosumab should not discontinue it without beginning bisphosphonate or other medicine in order to prevent rebound bone turnover and to prevent rapid decrease in bone mineral density and increase in fracture risk.

The Endocrine Society’s guidelines differ in some ways from the American College of Physicians (ACP) guidelines from 2017, particularly in how long patients should take certain medicines and how often they should get a bone density test.

ACP President Dr. Robert McLean told Medscape Medical News that his society’s guidelines are broad and might not apply to every patient. “The ACP guideline process is very strictly evidence-based when it decides what recommendations it can make and what recommendations it cannot make. This clearly leads to some limitations, because there are simply not adequately designed trials to answer the clinical questions that arise in some specific patient situations.”


The Endocrine Society Guidelines provide a great blueprint for patients and their doctors. If you are newly diagnosed with osteoporosis or have had a fracture, talk with your doctor about the bone health steps to follow.

Now is the time to take action to build and keep your bones strong. You can find a roadmap for this journey on our website, americanbonehealth.org.

As a service to our readers, American Bone Health provides access to our library of archived content. Please note the date of the last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Reviewed: 7/31/19


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