Overview of AACE Osteoporosis Treatment Guidelines

By:
iVillage Health & Well-Being Staff Writer

To ensure patients and physicians make appropriate choices with regard to postmenopausal osteoporosis, the American Association of Clinical Endocrinologists (AACE) has introduced The 2001 AACE Medical Guidelines for Clinical Practice for the Prevention and Management of Postmenopausal Osteoporosis. The guidelines provide a unified approach to osteoporosis management and are based on comprehensive review of current medical literature. Following are specific recommendations:

Who Should Be Evaluated

All adult women with a history of fractures from everyday activity

All women who are at risk for fractures at the start of menopause

All women 65 and older

Testing For Osteoporosis

• Bone Mineral Density (BMD) is the most accurate way to confirm a diagnosis of osteoporosis and determine its severity, assess fracture risk, identify patients requiring intervention and measure changes in bone mass over time in treated and untreated patients. AACE recommends bone density testing for the following patients:
  
  Perimenopausal/postmenopausal women at risk for fractures who are willing to consider treatment
  
  Women who have underlying conditions or are taking medications that cause bone loss
  
  Women undergoing osteoporosis treatment, to measure therapeutic response
  
  All women age 40 and older who have suffered a fracture

For those diagnosed with osteoporosis or at risk for the disease, AACE recommends the following:

• A complete medical history and physical examination
  
  
• Basic laboratory tests, including a complete blood cell count, serum tests (particularly calcium, total protein, electrolytes and liver enzymes), and urinary calcium excretion
  
  
• As indicated
  
  Standard X-rays to study the spine, pelvis and wrist in patients with known or suspected fractures
  
  Biochemical markers of bone turnover to assess fracture risk in elderly patients, measure therapeutic response to treatment agents, and identify patients suffering from rapid bone loss
  
  Additional tests if initial findings suggest bone loss may be caused by an underlying condition
  
  
• Assessment of patient's reliability, understanding and willingness to accept available interventions

Osteoporosis Prevention

Goals of prevention include maximizing peak bone mass at skeletal maturity, preventing bone loss, preserving the structural integrity of the skeleton, and preventing fractures

Prevention basics include a balanced diet, sufficient amounts of calcium and vitamin D, regular weight-bearing exercise (walking, biking, etc.), avoidance of tobacco, caffeine and alcohol

Osteoporosis Treatment

Goals are to prevent fractures, stabilize or moderately increase bone mass, relieve fracture symptoms, maximize physical function

Candidates for treatment include all women with fractures from everyday activity, those with low bone density or borderline-low bone density with risk factors, those who do not respond to preventive therapy

Therapies recommended by AACE include:

FDA-approved agents, including bisphosphonates, calcitonin, estrogen and raloxifene

Non-prescription agents for which there is clinical evidence of efficacy and safety such as vitamin D and calcium.

Endocrinologists and Osteoporosis Management

Osteoporosis is a complex metabolic bone disorder that often requires treatment by an endocrinologist. According to the AACE guidelines, primary care physicians should consider a referral to an endocrinologist when the patient has osteoporosis that is severe or has unusual features; has very low bone density; is young yet has osteoporosis; fails to respond to treatment; fractures despite normal bone density or treatment, or has a known or suspected underlying cause.

For a complete version of the AACE guidelines, please go to www.aace.com.