The management of postmenopausal osteoporosis (PMO) in routine clinical practice differs considerably from guideline recommendations. The objective of our study was to reach a consensus on the management of PMO, considering prevention, diagnosis, treatment and follow-up, according to expert opinion in Spain.
A two-round Delphi technique was conducted, including 38 experts. The questionnaire contained 35 sections, each one including 1–10 questions (n = 308) based on a literature review and contributions from the scientific steering committee. Each question was scored by experts from the current (1 = no occurrence, 9 = occurrence in all cases), wish (1 = total rejection; 9 = wish) and prediction (1 = no occurrence at all; 9 = occurs with maximum probability) perspectives. Consensus (wish and prediction perspectives) was considered when ≥75% of experts scored 7–9 (agreement) or 1–3 (disagreement).
Overall, consensus was achieved on 75% of questions. While protocols of clinical management and consultation/referral should be followed, their implementation is unlikely. Furthermore, the medical specialties currently involved in PMO management are poorly defined. PMO patients without fracture should be managed (prevention, diagnosis, treatment and follow-up) in both primary care and rheumatology settings; however, experts predicted that only treatment and follow-up will be assumed by these specialties. A multidisciplinary team should be involved in patients with fracture. No assessment tools are usually applied, and prediction indicated that they will not be used.
Efforts should be focused on questions with high divergence between wishes and predictions, defining actions that will improve PMO management. Collaboration between scientific societies and health authorities to address the identified opportunities of improvement is proposed.
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Sponsorship and article processing charges for this study were funded by Amgen S.A. Writing assistance was provided by Claire Desborough from Amgen. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. The authors wish to express their gratitude to: Dr. Rafael Sánchez-Borrego, member of the Asociación Española para el Estudio de la Menopausia (AEEM), Dr. Manuel Díaz, member of the Fundación Hispana de Osteoporosis y Enfermedades Metabólicas (FHOEMO), Dr. Manuel Mesa, member of the Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT), Dr. Esteban Jódar, member of the Sociedad Española de Endocrinología y Nutrición (SEEN), Dr. Pedro Carpintero, member of the Sociedad Española de Fracturas Osteoporóticas (SEFRAOS), Dr. Carmen Navarro, member of the Sociedad Española de Geriatría y Gerontología (SEGG), Dr. Carmen Valdés, member of the Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Dr. Vicente Giner, member of the Sociedad Española de Medicina de Familia y Comunitaria (SEMFyC), Dr. José Carlos Bastida, member of the Sociedad Española de Médicos Generales y de Familia (SEMG), Dr. José Luis Pérez, member of the Sociedad Española de Medicina Interna (SEMI), Dr. Alberto García, member of the Sociedad Española de Reumatología (SER), Dr. Elena Martínez, member of the Sociedad Española de Rehabilitación y Medicina Física (SERMEF) and Dr. Santiago Palacios, member of the Sociedad Iberoamericana de Osteología y Metabolismo Mineral (SIBOMM), for their participation in this study.
The authors Javier del Pino Montes, Josep Blanch, Xavier Nogués, María Jesús Moro and María del Carmen Valero have nothing to disclose. Laura Canals works at Amgen S.A. Luis Lizán works for an independent research institution and received payment for his contribution to the development and coordination of the original research project, as well as the drafting of this manuscript.
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del Pino-Montes, J., Blanch, J., Nogués, X. et al. Expert Consensus on the Management of Patients with Postmenopausal Osteoporosis in the Spanish Healthcare System. Adv Ther 33, 658–669 (2016). https://doi.org/10.1007/s12325-016-0314-9
- Postmenopausal osteoporosis