2012 update of French guidelines for the pharmacological treatment of postmenopausal osteoporosis

Objectives: To update the evidence-based position statement published by the French National Authority for Health (HAS) in 2006 regarding the pharmacological treatment of postmenopausal osteoporosis, under the auspices of the French Society for Rheumatology and Groupe de Recherche et d'Information sur les Osteoporoses (GRIO), and with the participation of several learned societies (College National des Gynecologues et Obstetriciens Francais, Groupe d'Etude de la Menopause et du Vieillissement hormonal, Societe Francaise de Chirurgie Orthopedique, Societe Francaise d'Endocrinologie, and Societe Francaise de Geriatrie et de Gerontologie). Methods: A multidisciplinary panel representing the spectrum of clinical specialties involved in managing patients with postmenopausal osteoporosis developed updated recommendations based on a systematic literature review conducted according to the method advocated by the HAS. Results: The updated recommendations underline the need for osteoporosis pharmacotherapy in women with a history of severe osteoporotic fracture. In these patients, any osteoporosis medication can be used; however, zoledronic acid is the preferred first-line medication after a hip fracture. In patients with non-severe fractures or no fractures, the appropriateness of osteoporosis pharmacotherapy depends on the bone mineral density and FRAX (R) values; any osteoporosis medication can be used, but raloxifene and ibandronate should be reserved for patients at low risk for peripheral fractures. Initially, osteoporosis pharmacotherapy should be prescribed for 5 years. The results of the evaluation done at the end of the 5-year period determine whether further treatment is in order. Conclusions: These updated recommendations are intended to provide clinicians with clarifications about the pharmacological treatment of osteoporosis. (C) 2012 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.