Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women
Authors: Mary Ann Forciea, Robert M. McLean, Amir Qaseem
Journal: Annals of Internal Medicine (2017)

Letters19 December 2017Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and WomenMary Ann Forciea, MD, Robert M. McLean, MD, and Amir Qaseem, MD, PhD, MHAMary Ann Forciea, MDUniversity of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.), Robert M. McLean, MDYale School of Medicine, New Haven, Connecticut (R.M.M.), and Amir Qaseem, MD, PhD, MHAAmerican College of Physicians, Philadelphia, Pennsylvania (A.Q.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0490 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Frank that evidence-based guidelines are important for providing high-quality care to patients with osteoporosis. Although we recognize the evidence that raloxifene reduces vertebral (but not nonvertebral or hip) fractures, we concluded that the potential harms of selective estrogen receptor modulator therapy outweigh the potential benefits, particularly in light of other available treatments (1, 2). Dr. Frank correctly notes that teriparatide has anabolic effects on bone. Parenthetically combining all of the treatments together as antiresorptive agents was an oversight on our part.Dr. Sugiyama provides interesting insight into the physiology of mechanical factors involved in ...References1. Qaseem A, Forciea MA, McLean RM, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med. 2017;166:818-39. [PMID: 28492856]. doi:10.7326/M15-1361 LinkGoogle Scholar2. Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Booth MJ, et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med. 2014;161:711-23. [PMID: 25199883]. doi:10.7326/M14-0317 LinkGoogle Scholar3. Schwartz AV, Bauer DC, Cummings SR, Cauley JA, Ensrud KE, Palermo L, et al; FLEX Research Group. Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial. J Bone Miner Res. 2010;25:976-82. [PMID: 20200926] doi:10.1002/jbmr.11 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.)Yale School of Medicine, New Haven, Connecticut (R.M.M.)American College of Physicians, Philadelphia, Pennsylvania (A.Q.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1361. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTreatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians Amir Qaseem , Mary Ann Forciea , Robert M. McLean , Thomas D. Denberg , and Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women Emily Frank Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women E. Michael Lewiecki Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women Susan Ott Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women Toshihiro Sugiyama Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women John J. Carey , E. Michael Lewiecki , Robert D. Blank , Chris R. 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Miller Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women Olivier Lamy , Bérengère Aubry-Rozier , and Elena Gonzalez-Rodriguez Metrics Cited byContributions of stem cell engineering to new therapies for joint and bone diseasesAnti-Osteoporosis Effect of Heme on Osteoblast Pre-Cells and Rat ModelMicroRNA-197-3p Inhibits the Osteogenic Differentiation in Osteoporosis by Down-Regulating KLF 10Prevalence of and Risk Factors for Community-Based Osteoporosis and Associated Fractures in Beijing: Study Protocol for a Cross-Sectional and Prospective StudyAnti-osteoporosis medication treatment pattern after osteoporotic fracture during 2010–2016 in Fujian, ChinaEffects of bushen qianggu method for primary osteoporosisBone Cell Communication Factors Provide a New Therapeutic Strategy for OsteoporosisTherapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort studyAcupuncture for primary osteoporosisThe Long Non-coding RNA-ORLNC1 Regulates Bone Mass by Directing Mesenchymal Stem Cell FateRomosozumab treatment in postmenopausal women with osteoporosis: a meta-analysis of randomized controlled trials 19 December 2017Volume 167, Issue 12Page: 904KeywordsBoneBone densityDisclosureExerciseForecastingHip fracturesOsteoporosisPatientsTreatment guidelinesVitamin D ePublished: 19 December 2017 Issue Published: 19 December 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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