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Expert Consensus on the Management of Patients with Postmenopausal Osteoporosis in the Spanish Healthcare System

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Abstract

Introduction

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.

Methods

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).

Results

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.

Conclusion

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.

Funding

Amgen S.A.

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References

  1. González-Macías J, Del Pino-Montes J, Olmos JM, Nogués X. Clinical practice guidelines for posmenopausal, glucocorticoid-induced and male osteoporosis. Spanish Society for Research on Bone and Mineral Metabolism (3rd updated version 2014). Rev Clin Esp. 2015;215(9):515–26.

  2. Serra JA, Garrido G, Vidán M, Maranón E, Branas F, Ortiz J. Epidemiology of hip fractures in the elderly in Spain. An Med Interna. 2002;19:389–95.

    CAS  PubMed  Google Scholar 

  3. Hansen LB. Bridging the gap between evidence and practice in osteoporosis. Am J Health Syst Pharm. 2008;65:297.

    Article  PubMed  Google Scholar 

  4. Weiss TW, Siris ES, Barrett-Connor E, Miller PD, McHorney CA. Osteoporosis practice patterns in 2006 among primary care physicians participating in the NORA study. Osteoporos Int. 2007;18:1473–80.

    Article  CAS  PubMed  Google Scholar 

  5. Del Pino-Montes J, Blanch J, Lizan L, Marín N. Patient with fracture due to postmenopausal osteoporosis in Spain: medical care pathway. Rev Osteoporos Metab Min. 2012;4:27–35.

    Google Scholar 

  6. Dajani JS, Sincoff MZ, Talley WK. Stability and agreement criteria for the termination of Delphi Studies. Technol Forecast Soc Chang. 1979;13:83–90.

    Article  Google Scholar 

  7. Habibi A, Sarafrazi A, Izadyar S. Delphi technique theoretical framework in qualitative research. IJES. 2014;3(4):8–13.

    Google Scholar 

  8. Unnanuntana A, Gladnick BP, Donnelly E, Lane JM. The assessment of fracture risk. J Bone Joint Surg Am. 2010;92(3):743–53.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, National Osteoporosis Guideline Group. Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos Int. 2008;19(10):1395–408.

    Article  CAS  PubMed  Google Scholar 

  10. Zethraeus N, Borgström F, Ström O, Kanis JA, Jönsson B. Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model. Osteoporos Int. 2007;18(1):9–23.

    Article  CAS  PubMed  Google Scholar 

  11. McGrother CW, Donaldson MM, Clayton D, Abrams KR, Clarke M. Evaluation of a hip fracture risk score for assessing elderly women: the Melton Osteoporotic Fracture (MOF) study. Osteoporos Int. 2002;13(1):89–96.

    Article  CAS  PubMed  Google Scholar 

  12. Pérez L, Alonso A, Roig D, García A, Guañabens N, Peris P, et al. 2011 Up-date of the consensus statement of the Spanish Society of Rheumatology on osteoporosis. Reumatol Clin. 2011;7:357–79.

    Article  Google Scholar 

  13. Osteoporosis Study and Research Group (GEIOS) of the Spanish Society of Orthopaedic Surgery and Traumatology (SECOT). Multidisciplinary treatment of osteoporotic fractures. Vías clínicas. Madrid: Editorial SECOT; 2011.

    Google Scholar 

  14. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, National Osteoporosis Foundation, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Osteoporosis Study and Research Group (GEIOS) of the Spanish Society of Orthopaedic Surgery and Traumatology (SECOT). Multidisciplinary treatment of osteoporotic fractures. Multidisciplinary treatment of hip fracture. Madrid: Editorial SECOT; 2009.

    Google Scholar 

  16. Meeta, Harinarayan CV, Marwah R, Sahay R, Kalra S, Babhulkar S. Clinical practice guidelines on postmenopausal osteoporosis: an executive summary and recommendations. J Midl Health. 2013;4(2):107–26.

    Article  CAS  Google Scholar 

  17. Rizzoli R. Long-term strategy in the management of postmenopausal osteoporosis. Joint Bone Spine. 2007;74:540–3.

    Article  PubMed  Google Scholar 

  18. Bernard M, González CM, Fernández M, Fernández J, Maeso R, Garcés MV. Rheumatology and osteoporosis (RETOSS): a vision of postmenopausal osteoporosis in rheumatology departments throughout Spain. Reumatol Clin. 2011;7:13–9.

    Google Scholar 

  19. O’Malley AS, Reschovsky JD. Referral and consultation communication between primary care and specialist physicians: finding common ground. Arch Intern Med. 2011;171:56–65.

    PubMed  Google Scholar 

  20. Liss DT, Chubak J, Anderson ML, Saunders KW, Tuzzio L, Reid RJ. Patient-reported care coordination: associations with primary care continuity and specialty care use. Ann Fam Med. 2011;9:323–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Naranjo A, Ojeda-Bruno S, Bilbao A, Quevedo JC, Henríquez-Hernández LA, Rodríguez-Lozano C. Results of a model of secondary prevention for osteoporotic fracture coordinated by rheumatology and focused on the nurse and primary care physicians. Reumatol Clin. 2014;10:299–303.

    Article  PubMed  Google Scholar 

  22. Orcel P, Funck-Brentano T. Medical management following an osteoporotic fracture. Orthop Traumatol Surg Res. 2011;97:860–9.

    Article  CAS  PubMed  Google Scholar 

  23. Naranjo A, Rosas J, Ojeda S, Salas E, CANAL group. Management of osteoporosis in primary care before and after the result of densitometry: treatments in real practice versus the recommended by guidelines. CANAL study. Reumatol Clin. 2013;9:269–73.

    Article  PubMed  Google Scholar 

  24. Jódar E. Consensual conclusions of the I Multidisciplinary Forum on the management of patients with high risk of osteoporotic fracture (HRF). Rev Osteoporos Metab Miner. 2010;2:79–86.

    Google Scholar 

  25. Carbonell C, Abizanda M, Pérez M, Roset M, Nogués X. Primary care perception of clinical management of osteoporosis. The influence of healthcare policies. Semergen. 2009;35:122–30.

    Article  Google Scholar 

  26. Quesada JM, García EI, Cuenca R. Conditioning factors of the effectiveness of a drug treatment in osteoporosis. Adherence and complicance. Semergen. 2007;33:478–84.

    Article  Google Scholar 

  27. Peiró S, Portella E. Consensus doesn’t always mean agreement: limitations of consensus methods in health services. Gac Sanit. 1993;7:294–300.

    Article  Google Scholar 

  28. McKercher HG, Crilly RG, Kloseck M. Osteoporosis management in long-term care. Survey of Ontario physicians. Can Fam Phys. 2000;46:2228–35.

    CAS  Google Scholar 

  29. Dreinhöfer KE, Anderson M, Féron J-M, Herrera A, Hube R, Johnell O, et al. Multinational survey of osteoporotic fracture management. Osteoporos Int. 2005;16:44–53.

    Article  Google Scholar 

Download references

Acknowledgments

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.

Disclosures

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.

Compliance with Ethics Guidelines

This article does not contain any new studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Servicio de Reumatología; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III FEDER, Salamanca, Spain

    Javier del Pino-Montes

  2. Servicio de Reumatología, Hospital del Mar, Barcelona, Spain

    Josep Blanch

  3. Servicio de Medicina Interna; IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III FEDER, Barcelona, Spain

    Xavier Nogués

  4. Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain

    María Jesús Moro

  5. Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Spain

    María del Carmen Valero

  6. Amgen S.A., Barcelona, Spain

    Laura Canals

  7. Outcomes’10, Universitat Jaume I, Castellón, Spain

    Luis Lizán

Authors
  1. Javier del Pino-Montes
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  2. Josep Blanch
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  3. Xavier Nogués
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  4. María Jesús Moro
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  5. María del Carmen Valero
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  6. Laura Canals
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  7. Luis Lizán
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Correspondence to Javier del Pino-Montes.

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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

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  • DOI: https://doi.org/10.1007/s12325-016-0314-9

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