ISCD Response to the American College of Physicians (ACP) Clinical Practice Guidelines for Treating Osteoporosis

Middletown, CT – The International Society for Clinical Densitometry, the world’s largest
professional organization for bone densitometry, acknowledges and welcomes guidelines promoting best practices for quality bone density testing and treatment of osteoporosis. Our mission is to promote excellence in skeletal health assessment.

We welcome the efforts of the American College of Physicians to update their guidelines for the treatment of osteoporosis. Osteoporosis is a devastating disease, affecting millions of Americans and hundreds of millions of people all over the world. Fractures are the clinical consequence of this disease. The annual risk of fracture for a postmenopausal American woman exceeds her annual combined risk of cardiovascular disease and invasive breast cancer. Today in the USA, 1 in 5 people die within a year of breaking their hip; the mortality following spine fracture is similar, but even starker among elderly Medicare beneficiaries: only 50% are alive at 3 years, 30% at 5 years and 10% at 7 years. Fractures are preventable. National figures show the cost of treating osteoporotic fractures is close to $20 billion, while around $1 billion is being spent on prevention.

In recent years, there is an alarming trend of fewer people being diagnosed, tested, and treated for osteoporosis. We are very concerned that Recommendation 4 (“ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women”) will exacerbate this problem, leading to more people not taking or discontinuing their treatment, rather than helping solve the crisis in osteoporosis care.

We believe monitoring bone mineral density (BMD) is an effective evidence-based clinical tool to help clinicians monitor and manage their patients, assess treatment effect, and track progress in reaching treatment goals. It is accepted best practice to monitor BMD, and it makes sense. We are very concerned that use of ‘weak’ status is being employed to disregard this critical step in patient care, which is and has been the standard of care for many years, both in the USA and around the world. We respectfully disagree with this statement and encourage patients and health care providers to continue to monitor BMD amongst people with or at high risk for developing osteoporosis.

New dual-energy X-ray absorptiometry (DXA) tools also help clinicians assess incident vertebral fractures and monitor for potential treatment side effects, enhancing its value. Modern DXA is a powerful and essential tool for monitoring patients and should not be discarded without robust evidence of a better alternative.

The International Society for Clinical Densitometry is the leading membership organization for professionals working to assess, monitor and treat skeletal health. Since 1993, ISCD has educated and certified practitioners performing and promoting quality skeletal health assessments with the goal of improving diagnosis, treatment and care.

Last modified: May 12, 2017