Application of UK and US osteoporosis treatment guidelines varies extensively
MedWire News: Researchers from New Zealand have found striking differences in the recommendations for management of skeletal health when applying US and UK osteoporosis treatment guidelines to elderly women.
“After the advent of absolute fracture risk calculators, guidelines for the management of osteoporosis released by the US-based National Osteoporosis Foundation (NOF) and the UK-based National Osteoporosis Guidelines Group (NOGG) differ markedly in their approaches to treatment recommendations,” explain Mark Bolland and Andrew Grey from the University of Auckland.
They add: “The NOF intervention thresholds are based upon economic cost-effectiveness analyses, whereas the NOGG guidelines recommend intervention if the probability of fracture exceeds that of a person of the same age who has suffered a previous osteoporotic fracture.”
In the present study, Boland and Grey compared the recommended management, based on the NOF and NOGG guidelines, to fracture outcomes in a cohort of 1471 postmenopausal women (mean age 74 years) who took part in a study of calcium supplementation.
Over a mean follow-up of 4.4 years, 143 (10%) women sustained a nontraumatic osteoporotic fracture and 21 (1.4%) sustained a nontraumatic hip fracture.
Applying the NOF guidelines to this cohort would have led to 97% of women undergoing bone densitometry to assess bone mineral density (BMD) and 48 [in abstract]% being treated. Applying the NOGG guidelines would have led to 13% of the cohort undergoing bone densitometry and 21% being treated.
Applying the NOF guidelines identified 76% of women with hip fractures and 63% with osteoporotic fractures who needed treatment. However, applying the NOGG guidelines identified only 38% of women with hip fractures and 27% with osteoporotic fractures who needed treatment.
“The NOGG guidelines identify only a minority of fracture cases; the NOF guidelines identify the majority of fracture cases, but at the expense of greater resource utilization,” remark Boland and Grey.
“Both strategies lead to recommendations for reassurance in significant numbers of women who subsequently sustain fragility fractures,” they add.
The researchers conclude in the Journal of Clinical Endocrinology and Metabolism “These findings underline the limitations of the currently available tools for identifying individuals at risk for fracture, and therefore of reducing the fracture burden in the community.”
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By Laura Dean