BMS consensus statement

Summary

This BMS Consensus Statement on estrogen and non estrogen-based treatment options for osteoporosis responds to the controversies about the benefits and risks of individual agents. Treatment choices should be made on up-to-date evidence-based information and targeted to individual women’s needs.

Summary practice points

• Provision of adequate dietary calcium and supplemental vitamin D is usually considered a part of osteoporosis management.
• The effects of calcium and vitamin D supplements alone on fracture reduction are however not proven.
• HRT reduces the risk of both spine and hip as well as other osteoporotic fractures.
• Estrogen remains the treatment of choice for osteoporosis prevention in younger women experiencing menopause. It is especially important in those with premature ovarian insufficiency and early menopause. It should also be considered for osteoporosis prevention in women over the age of 60 who continue to benefit from HRT in terms of menopause symptom relief.
• Bisphosphonates are effective for treatment of established osteoporosis, reducing both spine and hip fractures.
• Bisphosphonates have a very long skeletal retention time and hence should be used with caution in younger postmenopausal women (e.g. those aged below 65 years).
• Denosumab is an effective treatment for reducing spine and hip fractures in osteoporotic women.
• Denosumab should be avoided in women with increased susceptibility to infections. There may be an increased risk of fractures after denosumab discontinuation. Specialist support is recommended as alternative therapies will be needed for ongoing management to avoid the risk of vertebral fracture.
• PTH, PTH receptor agonists and Romozosumab all increase bone density and result in fracture reduction but their high costs limit widespread use.