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Rheumatology International

, Volume 38, Issue 12, pp 2193–2208 | Cite as

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

  • Joanna E. M. SaleEmail author
  • Matthew Gray
  • Daniel Mancuso
  • Taucha Inrig
  • Gilles Boire
  • Marie-Claude Beaulieu
  • Larry Funnell
  • Earl Bogoch
Review

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

Osteoporosis Risk assessment Drug therapy Patient care 

Notes

Acknowledgements

This study was funded by the Canadian Institutes of Health Research (Funding Reference Number PCS-146431). Joanna Sale holds a Canadian Institutes of Health Research New Investigator Salary Award (Funding Reference Number COB-136622).

Author contributions

JS, GB, MCB, EB, and LF contributed to the conception and design of the study. JS, MG, DM, and TI contributed to data extraction. All authors contributed to the analysis and interpretation. JS wrote the first draft of the manuscript and all authors contributed to editing and revising the manuscript.

Compliance with ethical standards

Conflict of interest

Joanna Sale, Matthew Gray, Daniel Mancuso, Taucha Inrig, Gilles Boire, Marie-Claude Beaulieu, and Larry Funnel declare that they have no conflict of interest. Earl Bogoch received honoraria and consulting fees from Amgen Canada Inc., outside the scope of this study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Musculoskeletal Health and Outcomes ResearchLi Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  2. 2.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  3. 3.Department of Medicine, Faculty of Medicine and Health SciencesUniversité de SherbrookeSherbrookeCanada
  4. 4.Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health SciencesUniversité de SherbrookeSherbrookeCanada
  5. 5.Osteoporosis CanadaTorontoCanada
  6. 6.Department of SurgeryUniversity of Toronto, St. Michael’s HospitalTorontoCanada

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