Loyola Endocrinologist Pens New Osteoporosis Rules | Loyola Medicine
Tuesday, November 22, 2016

Loyola Endocrinologist is First Author of New Osteoporosis Guidelines

Pauline M. Camacho, MD, FACE

MAYWOOD, IL – Osteoporosis is preventable and treatable, but only a small proportion of people at risk for fractures are evaluated and treated, according to new osteoporosis guidelines written by an expert panel headed by Loyola Medicine endocrinologist Pauline M. Camacho, MD, FACE.

The guidelines recommend that all postmenopausal women aged 50 and older be evaluated for osteoporosis risk. Such evaluation should include a detailed history, physical exam and clinical fracture risk assessment.

Dr. Camacho is first author of the guidelines, which were developed by the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology and published in the journal Endocrine Practice. Dr. Camacho is president of the AACE, director of Loyola Medicine’s Osteoporosis and Metabolic Bone Disease Center and a professor in the division of endocrinology of Loyola University Chicago Stritch School of Medicine.

Osteoporosis is a silent skeletal disorder characterized by compromised bone strength that increases the risk of fracture. Bone strength has two main features: bone density and bone quality.

The guidelines' recommendations are graded from A to D. Most recommendations, including the recommendation to evaluate all women 50 and older, are graded B, meaning they are based on at least one well-designed study.

Recommendations with an A grade are based on the most convincing evidence from multiple gold-standard clinical trials. A-grade recommendations include:

  • Provide counseling on reducing risk of falls, particularly among the elderly.
  • Strongly recommend medications for patients with osteopenia or low bone mass and a history of a fragility fracture of the hip or spine. (Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis. A fragility fracture is a fracture that results from a fall from a standing height or less.)
  • Medications that reduce the risk of fractures include alendronate (Fosamax®), risedronate (Actonel®), zoledronic acid (Zometa®) and denosumab (Prolia® and Xgeva®).
  • Treatment with teriparatide (Forteo®) should be limited to two years.
  • Successful treatment of osteoporosis is defined as stable or increasing bone mineral density with no evidence of new fractures or fracture progression.

The initial therapy should be guided by the patient’s fracture risk and the presence or absence of prior fragility fractures.

For patients with moderate fracture risk, the guidelines recommend that stable patients take a “drug holiday” after taking an oral bisphosphonate for five years or an intravenous bisphosphonate for three years. Patients at higher fracture risk should continue oral therapy for up to 10 years and IV therapy for up to six years. During the drug holiday in these higher fracture risk patients, another drug such as raloxifene or teriparatide could be considered.

The National Osteoporosis Foundation estimates that 10.2 million Americans have osteoporosis and an additional 43.4 million have low bone mass. More than two million osteoporosis-related fractures occur annually in the United States, and more than 70 percent of these occur in women. Among women aged 55 and older, the annual cost of caring for osteoporotic fractures exceeds the annual costs of caring for breast cancer, heart attacks and strokes.

“Despite these significant costs, fewer than 1 in 4 women aged 67 years or older with an osteoporosis-related fracture undergoes bone density measurement or begins osteoporosis treatment,” the guidelines state.

Risk factors for osteoporosis include age 65 or older, low body weight, family history of osteoporosis or fractures, smoking, early menopause and excessive alcohol intake (three or more drinks per day).

“Further study is needed to determine the most effective means of communicating benefit and risk in osteoporosis management,” the guidelines state. “The best available evidence at this time suggests that communication skills can be learned, decision aids may be helpful and that shared decision-making may improve clinical outcomes.”

The guidelines are titled, “American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis – 2016.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.