Shared Decision Making In Osteoporosis Treatment From The Mayo Clinic Shared Decision Making Resource Center

Recently I went through a shared decision making exercise with a patient who wanted help in deciding whether to take the osteoporosis medicine her provider had recommended. We used Resource (1) below along with background information from the other Resources below.

Resource (1),  Osteoporosis Decision Aid, from the Mayo Clinic Shared Decision Making National Resource Center.

Resources [I have listed all the Resources that I reviewed prior to counselling my patient on osteoporosis]:

(1) Osteoporosis Decision Aid from Mayo Clinic Shared Decision Making National Resource Center. You need to register (free) to use the site.

(2) Final Recommendation Statement Osteoporosis: Screening from The U.S. Preventive Services Task Force Current as of: January 2011.

(3) NOGG 2017: Clinical guideline for the prevention and treatment of osteoporosis [PDF] from The National Osteoporosis Guideline Group.

(4) FRAX ®Fracture Risk Assessment Tool

(5) AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS — 2016 [PubMed Abstract] [Full Text PDF]. Endocr Pract. 2016 Sep 2;22(Suppl 4):1-42. doi: 10.4158/EP161435.GL.

(6) AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS – 2016–EXECUTIVE SUMMARY [PubMed Abstract]. Endocr Pract. 2016 Sep 2;22(Suppl 4):1-42. doi: 10.4158/EP161435.GL

(7) Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians [Pubmed Abstract] [Full Text HTML] [Link To Download Full Text PDF]. Ann Intern Med. 2017 Jun 6;166(11):818-839. doi: 10.7326/M15-1361. Epub 2017 May 9.

(8) Evidence-based recommendations on the bisphosphonates alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid for treating osteoporosis. Technology appraisal guidance [TA464] Published date: 09 August 2017 Last updated: 07 February 2018:

The purpose of this technology appraisal was to establish at what level of absolute fracture risk bisphosphonates are cost effective. Please note that because of the reduction in prices for oral bisphosphonates over the last few years, the absolute risk level at which these drugs are cost effective is now very low. The absolute risk level at which oral bisphosphonates are recommended as treatment options in this guidance are therefore not clinical intervention thresholds. This technology appraisal guidance should be applied clinically in conjunction with:

  • NICE guideline on assessing the risk of fragility fractures (CG146) that defines who is eligible for osteoporotic fracture risk assessment.
  • NICE quality standard on osteoporosis (QS149) that defines the clinical intervention thresholds for the 10-year fracture probability of a major osteoporotic fracture, in those patients who have undergone fracture risk assessment. These thresholds are based on the NICE-accredited National Osteoporosis Guideline Group guideline.
  • The individual person’s circumstances, goals and informed preferences.

Further information is in the implementation section.

This guidance partially updates NICE technology appraisal guidance on raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women (TA160) and on raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (TA161).

(9) Osteoporosis – Quality standard [QS149] Published date: April 2017 from NICE

NICE has developed guidance and a quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside these quality statements.

Other quality standards that should be considered when commissioning or providing osteoporosis services include:

A full list of NICE quality standards is available from the quality standards topic library.

(10) Osteoporosis: assessing the risk of fragility fracture Clinical guideline [CG146] Published date: August 2012 Last updated: February 2017  from NICE

(11) UpToDate Pathways Management Of Osteoporosis In Women – podcast posted on June 17, 2017

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