Clinician Article

Management of Postmenopausal Osteoporosis: ACOG Clinical Practice Guideline No. 2.

Obstet Gynecol. 2022 Apr 1;139(4):698-717. doi: 10.1097/AOG.0000000000004730. (Review)
PMID: 35594133
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  • Geriatrics
    Relevance - 7/7
    Newsworthiness - 4/7
  • Endocrine
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Gynecology
    Relevance - 6/7
    Newsworthiness - 5/7
  • Rheumatology
    Relevance - 6/7
    Newsworthiness - 5/7


PURPOSE: To provide updated evidence-based recommendations for the treatment of postmenopausal osteoporosis.

TARGET POPULATION: Postmenopausal patients with primary osteoporosis.

METHODS: This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Gynecology and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.

RECOMMENDATIONS: This Clinical Practice Guideline includes updated recommendations on who should receive osteoporosis pharmacotherapy, the benefits and risks of available pharmacotherapy options, treatment monitoring and follow-up, and the role of calcium and vitamin D in the management of postmenopausal osteoporosis. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

Clinical Comments


Nice review of the literature, although this has been previously reported on multiple occasions. No new additions to the literature. May be more useful to the OB/GYN community who may not be current on non-specialty journals.


This guideline is consistent with what studies have shown and will be helpful for those who do not treat this condition on a daily basis.

Family Medicine (FM)/General Practice (GP)

This is an essential update on this topic and a valuable reference for practitioners.


Osteoporosis is a common condition affecting elderly persons. It is important to treat because it predisposes to fractures leading to poor outcomes affecting the person's independence and quality-of-life. The guidelines published by the ACOG are clear and practical helping the primary physician in managing osteoporosis.


Well-done practice guideline on an important topic.


This is a committee opinion on EBM regarding osteoporosis management. A practical updated guideline is strongly useful for every clinician.


Guidelines for OP management from ACOG.


There is a proliferation of guidelines in the literature on osteoporosis that every scientific society interested in this pathology emanates. In all these guidelines, there is almost never complete agreement on how to advise on osteoporosis prevention, diagnosis, and treatment. In the greater interest of science, physicians, and patients, a consensus conference is desirable between all these scientific societies with their shared osteoporosis guidelines.

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