2018 update of French recommendations on the management of postmenopausal osteoporosis

Objectives To update the 2012 recommendations on pharmacotherapy for postmenopausal osteoporosis, under the aegis of the Bone Task Force of the French Society for Rheumatology (SFR) and of the Osteoporosis Research and Information Group (GRIO), in collaboration with scientific societies (College national des generalistes enseignants, College national des gynecologues et obstetriciens francais, Federation nationale des colleges de gynecologie medicale, Groupe detude de la menopause et du vieillissement hormonal, Societe francaise de chirurgie orthopedique, Societe francaise dendocrinologie, and Societe francaise de geriatrie et de gerontologie). Methods Updated recommendations were developed by a task force whose members represented the medical specialties involved in the management of postmenopausal osteoporosis. The update was based on a literature review and developed using the method advocated by the French National Authority for Health (HAS). Discussion and conclusion The updated recommendations place strong emphasis on the treatment of women with severe fractures, in whom the use of osteoporosis medications is recommended. All the available osteoporosis medications are suitable in patients with severe fractures; zoledronic acid deserves preference as the fist-line drug after a hip fracture. In patients with or without non-severe fractures, the decision to use osteoporosis medications is based on bone mineral density values and in challenging cases, on probabilities supplied by prediction tools such as FRAX (R). All osteoporosis medications are suitable; raloxifene should be reserved for patients at low risk for peripheral fractures. The fracture risk should be reevaluated every 2 to 3 years to decide on the best follow-up treatment. These updated recommendations discuss the selection of first-line osteoporosis medications and treatment sequences. (C) 2018 Published by Elsevier Masson SAS on behalf of Societe francaise de rhumatologie.