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Rheumatol Int. 2018 Dec;38(12):2193-2208. doi: 10.1007/s00296-018-4181-3. Epub 2018 Oct 26.

Treatment recommendations based on fracture risk status are not consistently provided in osteoporosis guidelines.

Author information

1
Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. salej@smh.ca.
2
Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada. salej@smh.ca.
3
Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
4
Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Room 3853, Sherbrooke, QC, J1H 5N4, Canada.
5
Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue North, Sherbrooke, QC, J1H 5N4, Canada.
6
Osteoporosis Canada, 1200 Eglinton Avenue East, Suite 500, Toronto, ON, M3C 1H9, Canada.
7
Department of Surgery, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.

Abstract

We examined international osteoporosis guidelines to determine the tools used to assess fracture risk, the classification of fracture risk presented, and the recommendations based on fracture risk status. We conducted a document analysis of guidelines from the International Osteoporosis Foundation (IOF) website retrieved as of May 10, 2018, focusing on guidelines written in English only. Two reviewers independently reviewed each document and the following data were extracted: (1) fracture risk tool(s) endorsed; (2) classification system used to describe fracture risk status (e.g., low, moderate, high); and (3) recommendations based on risk status (e.g., pharmacological treatment). Two additional reviewers verified all data extraction. A total of 112 guidelines were listed on the IOF website, of which 94 were located either through the provided link or through a PubMed search. Of 70 guidelines written in English, 63 guidelines discussed the concept of fracture risk of which, 39 endorsed FRAX. Twenty-eight guidelines defined fracture risk categories or thresholds which determined recommendations. In total, 26 provided a risk category or threshold which constituted an indication for pharmacotherapy. Twelve guidelines reported a moderate, medium, or intermediate risk category which was associated with variable recommendations for testing and treatment. Despite the generally accepted international shift to fracture risk as a basis for treatment decisions, the majority of guidelines in English did not provide treatment recommendations based on fracture risk status. In guidelines with recommendations based on fracture risk status, thresholds and recommendations varied making international comparisons of treatment difficult.

KEYWORDS:

Drug therapy; Osteoporosis; Patient care; Risk assessment

PMID:
30367203
DOI:
10.1007/s00296-018-4181-3

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