Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline

J Clin Endocrinol Metab. 2019 May 1;104(5):1595-1622. doi: 10.1210/jc.2019-00221.


Objective: The objective is to formulate clinical practice guidelines for the pharmacological management of osteoporosis in postmenopausal women.

Conclusions: Evidence from clinical trials and insights from clinical experience with pharmacologic therapies for osteoporosis were critically evaluated in formulating this guideline for the management of postmenopausal osteoporosis. Patient preferences, data on adherence and persistence, and risks and benefits from the patient and provider perspectives were also considered in writing committee deliberations. A consensus by the Writing Committee members was achieved for four management principles: (i) The risk of future fractures in postmenopausal women should be determined using country-specific assessment tools to guide decision-making. (ii) Patient preferences should be incorporated into treatment planning. (iii) Nutritional and lifestyle interventions and fall prevention should accompany all pharmacologic regimens to reduce fracture risk. (iv) Multiple pharmacologic therapies are capable of reducing fracture rates in postmenopausal women at risk with acceptable risk-benefit and safety profiles.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Accidental Falls / prevention & control
  • Bone Density Conservation Agents / therapeutic use*
  • Calcitonin / therapeutic use
  • Calcium / therapeutic use
  • Clinical Decision-Making
  • Denosumab / therapeutic use*
  • Diphosphonates / therapeutic use*
  • Estrogen Receptor Modulators / therapeutic use
  • Estrogen Replacement Therapy
  • Female
  • Humans
  • Norpregnenes / therapeutic use
  • Osteoporosis, Postmenopausal / diagnostic imaging
  • Osteoporosis, Postmenopausal / drug therapy*
  • Osteoporotic Fractures / prevention & control*
  • Parathyroid Hormone-Related Protein / therapeutic use
  • Patient Preference
  • Raloxifene Hydrochloride / therapeutic use
  • Risk Assessment
  • Risk Reduction Behavior
  • Selective Estrogen Receptor Modulators / therapeutic use
  • Teriparatide / therapeutic use
  • Vitamin D / therapeutic use


  • Bone Density Conservation Agents
  • Diphosphonates
  • Estrogen Receptor Modulators
  • Norpregnenes
  • Parathyroid Hormone-Related Protein
  • Selective Estrogen Receptor Modulators
  • Teriparatide
  • Vitamin D
  • Denosumab
  • Raloxifene Hydrochloride
  • Calcitonin
  • abaloparatide
  • tibolone
  • Calcium