[Variability in the recommendations for the clinical management of osteoporosis]

Abstract

Background and objective: Analysis of the variability in the recommendations of the main guidelines and clinical documents for the management of osteoporosis.

Material and method: Searches were carried out in PubMed, Google, web pages of national and international scientific societies related to the management of osteoporosis, and agencies that develop guidelines. We analyzed guidelines and clinical documents that included recommendations for the indication of bone densitometry and/or pharmacological treatment, which could influence the management of osteoporosis in the Spanish National Health System, which have been published between 2006 and 2012.

Results: We included 12 documents. Eleven recommend performing bone densitometry upon assessing women risk factors, but the number and type of risk factors vary between documents: 6 recommend its implementation to all women over 65 years, 4 in men aged 65-70 years, and 3 when there is radiological suspicion of osteoporosis. There is agreement on the recommendations on the indication for densitometry to monitor drug response. In primary prevention, all national documents combined risk factors and densitometric osteoporosis and 3 of them recommend individual assessment according to risk factors. Most of the international guidelines require the calculation of risk with the FRAX(®) tool. In secondary prevention, all documents recommend treatment in cases of hip or clinical vertebral fracture; in men, and for the rest of fractures, the recommendations are heterogeneous.

Conclusions: Overall there is a high variability in the recommendations of guidelines and other documents for the management of osteoporosis.

Keywords: Clinical evidence; Clinical practice guidelines; Evidencia clínica; Guías de práctica clínica; Osteoporosis; Review; Revisión; Variabilidad; Variability.