A Review of Osteoporosis Diagnosis and Treatment Options in New and Recently Updated Guidelines on Case Finding Around the World Authors
First Online: 08 June 2011 DOI:
Cite this article as: Leslie, W.D. & Schousboe, J.T. Curr Osteoporos Rep (2011) 9: 129. doi:10.1007/s11914-011-0060-5 Abstract
Fracture rates are known to vary by more than an order of magnitude worldwide; therefore, a single approach cannot be universally applied to all countries. National considerations must reflect the burden of osteoporosis, available resources, the disease costs to the individual and society, and how these relate to competing health and other societal priorities. Recent developments in terms of diagnosis, fracture risk prediction, and therapeutic options have prompted many countries to review and update their clinical practice guidelines (CPGs) for the prevention and management of osteoporosis intended for use in primary care in the general adult population. This paper reviews recently updated CPGs from the following countries: Australia, Belgium, Canada, Germany, the United Kingdom, and the United States.
Keywords Osteoporosis Fracture Clinical practice guidelines Bone mineral density Diagnosis Treatment References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367(9527):2010–8.
Kanis JA, Melton III LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137–41.
Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468–89.
Kanis JA, McCloskey EV, Johansson H, Oden A, Melton III LJ, Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42(3):467–75.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.
Melton III LJ. Epidemiology worldwide. Endocrinol Metab Clin North Am. 2003;32(1):1–13.
Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. 2003;18(11):1947–54.
Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos M. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporosis International. 2001;12:271–8.
Papaioannou A, Adachi JD, Parkinson W, Stephenson G, Bedard M. Lengthy hospitalization associated with veretebral fractures despite control for comorbid conditions. Osteoporosis International. 2001;12(10):870–4.
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353(9156):878–82.
Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, et al. Mortality after osteoporotic fractures. Osteoporos Int. 2004;15(1):38–42.
Ioannidis G, Papaioannou A, Hopman WM, Khtar-Danesh N, Anastassiades T, Pickard L, et al. Relation between fractures and mortality: results from the Canadian multicentre osteoporosis study. CMAJ. 2009;181(5):265–71.
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone. 2003;32(5):468–73.
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B. Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int. 2004;15(2):108–12.
Adachi JD, Ioannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, et al. The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int. 2001;12(11):903–8.
Hallberg I, Rosenqvist AM, Kartous L, Lofman O, Wahlstrom O, Toss G. Health-related quality of life after osteoporotic fractures. Osteoporos Int. 2004;15(10):834–41.
Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002;17(7):1237–44.
Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD. Low bone mineral density and fracture burden in postmenopausal women. CMAJ. 2007;177(6):575–80.
Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. 2007;18(8):1033–46.
•• Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E. FRAX and its applications to clinical practice. Bone 2009 May;44(5):734–43.
An introduction to the WHO FRAX system that is transforming osteoporosis CPGs. FRAX integrates the influence of several well-validated risk factors for fracture with or without the use of BMD. Its use in fracture risk prediction is changing patient assessment, the evaluation of drug efficacy and reimbursement, as well as for health economics
Dawson-Hughes B. A revised clinician’s guide to the prevention and treatment of osteoporosis. J Clin Endocrinol Metab. 2008;93(7):2463–5.
Dawson-Hughes B, Tosteson AN, Melton III LJ, Baim S, Favus MJ, Khosla S, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19(4):449–58.
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19(4):385–97.
Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A. Case finding for the management of osteoporosis with FRAX((R))-assessment and intervention thresholds for the UK. Osteoporos Int. 2008;19(10):1395–408.
Lippuner K, Johansson H, Kanis JA, Rizzoli R. FRAX assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int. 2010;21(3):381–9.
Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2008;19(4):399–428.
Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G, Fukunaga M. Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res. 2003;18(8):1547–53.
Neuprez A, Johansson H, Kanis JA, McCloskey EV, Oden A, Bruyere O, et al. A FRAX model for the assessment of fracture probability in Belgium. Rev Med Liege. 2009;64(12):612–9.
• Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010 Nov 23;182(17):1864–73.
The Canadian CPG covers prevention, diagnosis and therapy of primary osteoporosis and common forms of secondary osteoporosis in adult women and men
•• The AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care 2003 Feb;12(1):18–23.
AGREE is an international collaboration of researchers and policy makers who seek to improve the quality and effectiveness of CPGs by establishing a shared framework for their development, reporting, and assessment
•• Scott NA, Moga C, Harstall C. Making the AGREE tool more user-friendly: the feasibility of a user guide based on Boolean operators. J Eval Clin Pract 2009 Dec;15(6):1061–73.
A Boolean-based approach to rating guidelines under the AGREE system. Good reliability has been achieved in feasibility tests
• Royal Australian College of General Practitioners RACGP. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and men. 2010. Melbourne, Royal Australian College of General Practitioners RACGP.
A literature review and CPG conducted on behalf of The Royal Australian College of General Practitioners to inform the development of an evidence-based CPG. The objective was to present the most recent evidence related to the management of osteoporosis to inform the development of evidence-based recommendations for general practitioners working in the Australian health care setting.
Royal Australian College of General Practitioners RACGP. Osteoporosis: a literature review of recent evidence in postmenopausal women and older men. 2010. Melbourne, Royal Australian College of General Practitioners RACGP.
• Body JJ, Bergmann P, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, et al. Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club. Osteoporos Int 2010 Oct;21(10):1657–80.
The Belgian Bone Club is a nonprofit scientific organization devoted to promoting understanding of osteoporosis and bone diseases. Several statements have been developed to cover common clinical problems in the management of osteoporosis
Body JJ, Bergmann P, Boonen S, Boutsen Y, Bruyere O, Devogelaer JP, et al. Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club. Osteoporos Int 2011 Mar 1.
Devogelaer JP, Goemaere S, Boonen S, Body JJ, Kaufman JM, Reginster JY, et al. Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int. 2006;17(1):8–19.
Brown JP, Josse RG. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002;167(10 Suppl):S1–S34.
• Schattauer 2011. DVO Guideline 2009 for Prevention, Diagnosis and Therapy of Osteoporosis in Adults. 2011. Germany, Schattauer 2011.
The DVO is the osteology umbrella organization of the scientific societies for Germany, Austria, and Switzerland. The 2009 update of the CPGs for the prevention, diagnosis, and therapy of osteoporosis in adults targets primary care and specialist physicians who are clinically involved in the care of persons with osteoporosis, and provides recommendations on both primary osteoporosis and common forms of secondary osteoporosis.
McCabe C, Claxton K, Culyer AJ. The NICE cost-effectiveness threshold: what it is and what that means. Pharmacoeconomics. 2008;26(9):733–44.
• National Institute for Health and Clinical Excellence (NICE). Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended). 2011. London, National Institute for Health and Clinical Ecellence NHS.
The UK NICE performed 16 systematic reviews of clinical effectiveness on “Osteoporosis: assessment of fracture risk and the prevention of osteoporotic fractures in individuals at high risk,” which are published as evidence reviews.
National Institute for Health and Clinical Excellence (NICE). Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (amended). 2011. London, National Institute for Health and Clinical Ecellence NHS.
National Institute for Health and Clinical Excellence (NICE). Denosumab for the prevention of osteoporotic fractures in postmenopausal women. 2010. London, National Institute for Health and Clinical Ecellence NHS.
National Institute for Health and Clinical Excellence (NICE). Clinical practice guideline for the assessment and prevention of falls in older people. 2004. London, National Institute for Health and Clinical Ecellence NHS.
• National Osteoporosis Guideline Group (NOGG). Osteoporosis Clinical guidelines for prevention and treatment Executive Summary. 2010. UK, National Osteoporosis Guideline Group (NOGG).
The UK NOGG reviewed the assessment and diagnosis of osteoporosis, the therapeutic agents available, and the manner in which these can be used to develop management strategies for the prevention of osteoporotic fracture in postmenopausal women and in men ages over 50 years.
• Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris ST, Hodgson SF, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract 2010 Nov;16 Suppl 3:1–37.
Update of the 2004 AACE recommendations on diagnosis and treatment of postmenopausal osteoporosis
Dawson-Hughes B, Looker AC, Tosteson AN, Johansson H, Kanis JA, Melton III LJ. The potential impact of new national osteoporosis foundation guidance on treatment patterns. Osteoporos Int. 2010;21(1):41–52.
• U.S.Preventive Services Task Force. Screening for osteoporosis: U.S. Preventive services task force recommendation statement. Ann Intern Med 2011 Mar 1;154(5):356–64.
Update of the 2002 USPSTF recommendations on screening for osteoporosis. The USPSTF evaluated evidence on the diagnostic accuracy of risk assessment instruments for osteoporosis and fractures, the performance of DXA and peripheral bone measurement tests in predicting fractures, the harms of screening for osteoporosis, and the benefits and harms of drug therapy for osteoporosis in women and men.
Nelson HD, Haney EM, Dana T, Bougatsos C, Chou R. Screening for osteoporosis: an update for the U.S. preventive services task force. Ann Intern Med. 2010;153(2):99–111.
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