UK clinical guideline for the prevention and treatment of osteoporosis

Abstract

Summary The National Osteoporosis Guideline Group (NOGG) has revised the UK guideline for the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. Accredited by NICE, this guideline is relevant for all healthcare professionals involved in osteoporosis management. Introduction The UK National Osteoporosis Guideline Group (NOGG) first produced a guideline on the prevention and treatment of osteoporosis in 2008, with updates in 2013 and 2017. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. Methods Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. Results Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment and intervention thresholds, management of vertebral fractures, non-pharmacological and pharmacological treatments, including duration and monitoring of anti-resorptive therapy, glucocorticoid-induced osteoporosis, and models of care for fracture prevention. Recommendations are made for training; service leads and commissioners of healthcare; and for review criteria for audit and quality improvement. Conclusion The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals involved in its management. This position paper has been endorsed by the International Osteoporosis Foundation and by the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.

EASL Clinical Practice Guidelines on sclerosing cholangitis

“…According to the World Health Organization, osteopenia is defined as a T-score between -1 and -2.5 SD as measured by DEXA, and osteoporosis by a T-score less than -2.5, derived from measurement at the femoral neck or the lowest value from either the lumbar spine or femoral neck. 137,138 People with PSC are at greatly increased risk of bone mass loss and osteoporosis. In 2 similarly sized PSC cohorts, the prevalence of osteoporosis was 11-15% and that of osteopenia around 40%.…”

“…Although data is lacking, supplementation of vitamin D in case of deficiency seems advisable and sufficient dietary intake of calcium and exercise should be advised according to current guidelines. 137,138 Fragility fractures significantly impair patients' quality of life. Fracture risk approximately doubles with every SD T-score reduction.…”

Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study

“…Estimating individual fracture risk and assessing against preset intervention thresholds are the most evidence-based and widely accepted methods for bone health management worldwide. 19 …”

“…These provide a prediction of the probability of future fragility fracture and thereby identify patients warranting bone protection therapy. Estimating individual fracture risk and assessing against preset intervention thresholds are the most evidence-based and widely accepted methods for bone health management worldwide 19…”

“…FRAX does not account for dose-responsiveness of several risk factors, such as smoking and alcohol, but does include the option of including a BMD measurement in the risk calculation. Besides calculating the 10-year probability of major osteoporotic fracture and hip fracture, FRAX (UK) provides guidance on intervention thresholds for further management (‘treat’ versus ‘lifestyle advice and reassure’) based on UK National Osteoporosis Guidelines Group guidance 19. The patient may be classified as having low (<11%), intermediate (11%–24%) or high (>25%) probability of major fracture.…”