Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases

Abstract

Background This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service. Results The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested. Conclusion A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management.

Consensus evidence-based clinical practice guidelines for the diagnosis and treat-to-target management of osteoporosis in Africa: an initiative by the African Society of Bone Health and Metabolic Bone Diseases

“…Therefore, repeat DXA scan should be considered after 2-3 years of the former scan, which has been recommended in this guideline. The target of bone mineral density (BMD) (in the range of − 1.5 to − 2) as suggested in this guideline agrees with those reported in other studies [19,30,39].…”

“…The developed guideline agrees with the published guidelines from individual African nations for the management of osteoporosis including Egypt [ 30 ] and South Africa [ 31 ] as well as the international guidelines [ 32 – 34 ]. The guideline recommends very early intervention with osteoanabolic agents, for patients who are at very high risk of fracture.…”

“…On the other hand, repeat DXA informs on the long-term treatment effect on BMD. The new concept of very high fracture risk and the development of new intervention thresholds [ 30 , 42 ] provide a new manifesto based on which this guideline has been developed. The very high fracture risk and the consequent further utility loss immediately after a subsequent fracture (imminent risk) suggest that preventive treatment given as soon as possible after fracture would avoid a higher number of new fractures and reduce the attendant morbidity, compared with the treatment given later [ 30 , 43 ].…”

The implication of adenosine receptor expression in prediction of methotrexate clinical response in Egyptian rheumatoid arthritis patients

“…Treatment depends mainly on disease modifying anti-rheumatic drug (DMARDs) with or without biological drugs according to patient response to treatment [2]. Despite of the major progress in the treatment of (RA) and the availability of new biologics and targeted therapies still the initial therapy of patients with RA is MTX [3].…”

Osteoporosis clinical practice guideline: romosozumab for treating severe osteoporosis – an update by the Egyptian Academy of Bone Health

“…Alternatively, anabolic therapy such as teriparatide, abaloparatide, or romosozumab might be offered particularly in patients with severe osteoporosis and very high fracture risk. All the recently published guidelines [3][4][5][6] as well as the Egyptian guidelines for osteoporosis [7] have endorsed a new policy to systematically personalize the pharmacological management strategy for osteoporotic patients based on refined risk stratification criteria [8]. Thus, the "anabolic first" approach has been endorsed for patients found to be at very high risk of fracture [9].…”