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Clinician’s guide for the management and research of osteoporosis in North African men: a guidelines comparison, a cost-effectiveness analysis, and a local algorithm

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Abstract

Summary

A local management algorithm and practice recommendations for the management of osteoporosis in Egyptian males were developed after assessing the applicability of current international recommendations and the cost effectiveness of local drugs. A systematic review and sensitivity analyses augmented the quality of the research efforts.

Purpose

Osteoporosis affects both men and women; however, no local recommendations for the condition are available for the male population. Therefore, this study was undertaken to produce recommendations for men based on the applicability of current international recommendations and the cost effectiveness of local drugs.

Methods

The International Osteoporosis Foundation website, EMBASE, and SUMSEARCH-2 databases were searched to identify all guidelines that included recommendations for males. Regional and international guidelines were then appraised using the Advancing Guideline Development, Reporting, and Evaluation in Healthcare-II tool. A cost-effectiveness analysis was conducted using the perspective of an uninsured patient, international outcomes, and local costs. Recommendations were then formulated using the Grading of Recommendations Assessment, Development and Evaluation guidelines, and symbolic representations.

Results

Twenty-six guidelines were found. Only one of the guidelines focused entirely on males, with the remainder making inferences based on recommendations for females. Six regional guidelines were mainly of low quality. Alendronate was considered to be the most cost-effective drug, while teriparatide was found to be unaffordable.

Conclusion

Recommendations for men with osteoporosis are based on that of women, and the topic lacks exploration in the Middle East. International recommendations and other guidelines were evaluated and adopted to create guidance for the management of osteoporosis in men for application in Egypt.

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Notes

  1. Providing comprehensive recommendations on when to treat secondary causes first or when (or how) to combine their therapy with bone-protective drugs for all types of secondary causes is beyond the scope of this work.

  2. Providing comprehensive recommendations on when to treat secondary causes first or when (or how) to combine their therapy with bone-protective drugs for all types of secondary causes is beyond the scope of this work.

  3. All treatment options should be prescribed only after taking into consideration the patient’s severity of osteoporosis, the site affected, risk factors, comorbid conditions, side effects of the drugs, availability, and costs affordability. Full prescribing information should be sought from sources such as the British National Formulary. We endorse NICE’s technology appraisal [79] to be used as a guide in case a decision regarding the agent to be used cannot be made.

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Acknowledgments

This research work was done as part of a dissertation for MSc of Endocrinology (USW) with Prof Atul Kalhan (FRCP, MD, MRCP Endocrinology) being the guiding supervisor for it.

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  1. Faculty of life sciences and education (FLSE), University of South Wales (USW), Llantwit Rd, Pontypridd, CF37 1DL, UK

    Ahmed S. Mettawi

  2. Department of Family Medicine, Kasralainy School of Medicine, Cairo University, Cairo, Egypt

    Saeed S. Soliman

  3. Department of Orthopaedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland

    Mohy E. Taha

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Mettawi, A.S., Soliman, S.S. & Taha, M.E. Clinician’s guide for the management and research of osteoporosis in North African men: a guidelines comparison, a cost-effectiveness analysis, and a local algorithm. Arch Osteoporos 15, 159 (2020). https://doi.org/10.1007/s11657-020-00830-4

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