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DOI:
https://doi.org/10.57187/5700

Medical guidelines

Vol. 156 No. 10 (2026)

Updated recommendations for osteoporosis treatment according to fracture risk: 2026 revision by the Swiss Association against Osteoporosis (SVGO)

Cite this as:
Swiss Med Wkly. 2026;156:5700
Published
08.10.2026

Summary

Osteoporosis remains a major public health burden in Switzerland and is still associated with a substantial treatment gap. These updated recommendations from the Swiss Association against Osteoporosis (SVGO) revise the 2020 risk-based framework by integrating advances in fracture-risk assessment, lifestyle management, anabolic therapy, treatment sequencing and treat-to-target concepts. Risk assessment should be based on Swiss Fracture Risk Assessment Tool (FRAX) probabilities, possibly refined by a FRAXplus approach. Five risk categories are retained – low, moderate, high, very high and imminent risk. Patients at imminent or very high risk should preferentially receive an anabolic-first strategy followed by antiresorptive consolidation. Within the anabolic class, romosozumab and abaloparatide may be preferred when the fastest and broadest bone mineral density (BMD) gain is needed, particularly at the hip. In high-risk patients, potent antiresorptives, i.e. bisphosphonates or denosumab, remain first line. In moderate-risk patients, lifestyle optimisation remains mandatory, and raloxifene or oral bisphosphonates are usually recommended, but in selected women with osteopenia or early osteoporosis, infrequent zoledronate emerges as a pragmatic preventive option. A treat-to-target concept based primarily on hip BMD is proposed, with reassessment after 2 years and treatment sequence chosen according to baseline BMD and urgency of fracture-risk reduction. These recommendations aim to improve implementation of fracture prevention in Switzerland while acknowledging reimbursement constraints and areas where evidence remains indirect.

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