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Editorial Postmenopausal Osteoporosis
2016 American Association of Clinical Endocrinologists/
American College of Endocrinology Clinical Practice
Guidelines on Postmenopausal Osteoporosis
Pauline M Camacho
Loyola University Osteoporosis and Metabolic Bone Disease Center, Maywood, Illinois, US
T he 2016 American Association of Clinical Endocrinologists/American College of Endocrinology Guidelines for postmenopausal
osteoporosis provides comprehensive guidance on the diagnosis, evaluation and treatment of postmenopausal osteoporosis.
A new diagnostic criterion which expands the diagnosis to patients with osteopenia and a high Fracture Risk Assessment Tool score
has been added to the old diagnostic criteria. Recommendations on duration of bisphosphonate therapy are clearly outlined and are based
on fracture risk stratification. The accompanying algorithm, which goes through all the steps from diagnosis to treatment and follow up is
a handy guide for clinicians.
Keywords Postmenopausal osteoporosis, American Association of Clinical
Endorinologists/American College of Endocrinology Guidelines, bone
mineral density, osteopenia, fracture risk
Disclosure: Pauline M Camacho has nothing to disclose in relation to this article.
This article is a short opinion piece and has not been submitted to external peer
reviewers. No funding was received for the publication of this article.
Authorship: All named authors meet the International Committee of Medical
Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility
for the integrity of the work as a whole, and have given final approval to the version
to be published.
Open Access: This article is published under the Creative Commons Attribution
Noncommercial License, which permits any noncommercial use, distribution,
adaptation, and reproduction provided the original author(s) and source are given
Received: October 25, 2016
Published Online: December 20, 2016
Citation: US Endocrinology, 2016;12(2):74–5
Corresponding Author: Pauline M Camacho, 2160 S. First Ave, Fahey Center Suite
137, Maywood, IL 60153, US. E: firstname.lastname@example.org
In September 2016, the latest American Association of Clinical
Endocrinologists (AACE)/American College of Endocrinology (ACE)
Guidelines for postmenopausal osteoporosis were published. This
contains very relevant information on the diagnosis, and long term
management of osteoporosis in postmenopausal women. Included in this
version is a user-friendly algorithm which clearly outlines the approach
to the choice of initial therapy, length of therapy, and what to do when
treatment is not working. 1
The diagnostic criteria for osteoporosis is similar to that in the previous
(2010) version of the guidelines. It is diagnosed based on the presence
of a fragility fracture in the absence of another metabolic bone disorder;
and a lumbar, total, femoral neck hip bone mineral density (BMD) T-score
of -2.5 or lower (with the distal radius 33% as an alternate site). However,
patients with osteopenia (T-score of -1.0 to -2.4) and a high fracture risk
score using the Fracture Risk Assessment Tool (FRAX ® ), may also be
diagnosed with osteoporosis. This expanded criteria is consistent with the
National Bone Health Alliance position statement on the clinical diagnosis
The choice of initial therapy would depend on the patient’s fracture risk.
Individuals with a higher fracture risk include those who are older, those
who have prior fractures, those with very low T-scores, and those who are
frail or are on glucocorticoid therapy. For higher fracture risk individuals,
an injectable agent such as denosumab, teriparatide or zoledronic acid
could be considered as initial therapy. Individuals at moderate risk may
be started on alendronate, risedronate, denosumab or zoledronic acid.
All four of these agents have proven fracture risk reduction in vertebral,
non-vertebral and hip sites. Alternative drugs include ibandronate
The recommended duration of therapy would also be based on the
patient’s fracture risk. Five years of oral bisphosphonates (BP) or three
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