Assessment and Treatment of Postmenopausal Osteoporosis: An Appraisal of International Guidelines

Recently, several updates in the assessment and treatment of postmenopausal osteoporosis guidelines were published. This review discusses international guidelines, including the algorithm for management of patients at risk of osteoporotic fracture from the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) 2020, The Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline (2019)/Guideline Update (2020), and the American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Due to the recent COVID-19 pandemics, the joint guidance on osteoporosis management in the era of COVID-19 pandemic will also be included. The criterion for diagnosis of osteoporosis has been published by AACE/ACE. All postmenopausal women of age ≥50 years old should be evaluated for osteoporosis risk. Those at very high risk for fracture are recommended to start treatment with anabolic agents and those at high risk for fracture are recommended to start treatment with antiresorptive agent such as bisphosphonates or denosumab. Intervention thresholds and treatment options vary from country to country. Physicians should individualize the treatment according to risks, benefits, patient preferences, as well as treatment accessibility.