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Implications of guidelines for osteoporosis and its treatment

Lookup NU author(s): Dr Stephen Tuck, Dr Elizabeth Little, Dr Terry Aspray

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2018.

For re-use rights please refer to the publisher's terms and conditions.


Abstract

© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. The development of clinical guidelines is now a more uniform process, with formalised methods to ensure that recommendations are based on current best available evidence from randomised controlled trials and systematic reviews. Over the past 20 years we have seen a growth in guidelines including those relating to osteoporosis, with recommendations varying between and within countries. Some guidelines are concerned with case finding and primary or secondary prevention, such as those produced by the National Institute for Health and Care Excellence (NICE CG146, TA-160, -161, -464), while others focus on specific conditions or risk factors associated with osteoporosis, such as the menopause, coeliac disease and eating disorder. Clinicians can be confused as to which to follow in any particular clinical scenario. International guidelines, such as those from North America (NOF, CAROC, AACE) and Scotland (SIGN 142), differ from those of England, Wales and Northern Ireland, with recent recommendations from NICE (TA464) shifting the focus of treatment from those at greatest fracture risk to an apparent blanket approach, based on cost-effectiveness, rather than clinical effectiveness. Osteoporosis treatment should be targeted at those who can benefit most, outweighing the potential for harm. If the low health economic threshold of NICE TA464 were adopted as a clinical threshold, the most important group-older people at greatest risk of fracture, would not be prioritised. We risk overwhelming clinical services, while causing harm to some at low fracture risk from adverse effects of treatment, yet failing to treat the older population at highest fracture risk.


Publication metadata

Author(s): Tuck S, Little EA, Aspray TJ

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2018

Volume: 47

Issue: 3

Pages: 334-339

Print publication date: 01/05/2018

Online publication date: 05/01/2018

Acceptance date: 20/11/2017

Date deposited: 18/12/2018

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: https://doi.org/10.1093/ageing/afx197

DOI: 10.1093/ageing/afx197


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