Executive Summary
- The burden of osteoporotic fractures notably hip fractures keeps growing with the increasing life expectancy and ageing of the world’s population.
- Development and approval of new bone-forming drugs have broadened the landscape of anti-osteoporosis treatment in postmenopausal women.
- Evolving concepts on imminent fracture risk and new treatment data consolidate an individualised approach in selection of anti-osteoporosis drugs based on the individual’s risk level.
- For patients with imminent or very high fracture risk, bone-forming drugs should be prioritised as the initial treatment option.
- For younger patients in their early years of menopause at low fracture risk, mild antiresorptive drugs such as raloxifene or hormone replacement therapy are preferred.
- For patients with age ≥65 years at high fracture risk, potent antiresorptive drugs such as bisphosphonates or denosumab are reasonable first-line therapy.
- Drug holidays are only applicable to patients who are no longer at high fracture risk after 5 years of oral or 3 years of iv bisphosphonate treatment. Drug holidays are inappropriate for patients on all other antiresorptive treatment.
- Denosumab discontinuation is associated with rapid rebound bone loss and a potential increase in risk of multiple vertebral fractures. Patients who discontinue denosumab are advised to receive a potent bisphosphonate with regular monitoring for excessive bone loss.
- Fracture liaison service plays an important role in bridging the care and treatment gap for patients after a fragility fracture.