I’ve reviewed these guidelines.
And I believe these guidelines are not very helpful to me and my patients for shared decision making about osteoporsis screening and treatment.
This is because the methodology used to define the Evidence levels and Strength of Recommendations [AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY PROTOCOL FOR STANDARDIZED PRODUCTION OF CLINICAL PRACTICE GUIDELINES, ALGORITHMS, AND CHECKLISTS – 2017 UPDATE (PubMed Abstract)] is unavailable (is only available to members of the AACE/ACE or behind a very expensive pay wall).
The discussion of the methodology in the article below for their recommendations is inadequate.
I did, however, include the summary tables from the article as they do summarize much useful information including the evaluation of secondary osteoporis.
The American Association of Clinical Endocrinologists/American College of Endrocrinology (AACE/ACE) 2016 Osteoporosis Guidelines are linked below. I use this post as I reviewed the PDF of the guidelines. In Resources after this post, I have posted links to other osteoporosis guidelines from other organization that I have reviewed.
The following are the tables from AACE/ACA Evidence Tables from Diagnosis and Treatment Of Postmenopausal Osteoporosis – 2016 [Link is to PDF]:
Summary of The AACE/ACE Treatment Algorithm:
Recomendation 4, above, to diagnose osteoporosis in patients with a high the FRAX fracture probablity score and osteopenia comes from a recommendation by the National Bone Health Alliance (an organization consisting of osteoporosis related businesses and professional medical societies).
While osteoporosis has traditionally been diagnosed based on T-scores less than–2.5 in the lumbar spine, total hip, femoral neck and/or 33% radius (6 [EL 4; review NE]), the AACE agrees with
the proposed new clinical diagnosis by the National Bone Health Alliance that osteoporosis may also be diagnosed in patients with osteopenia and increased fracture risk using FRAX® country-specific thresholds (12 [EL 4; NE], 13 [EL 2; RCCS], 14 [EL 4; review NE], 17 [EL 2; PCS]).
However, the American College of Physicians 2017 Osteoporosis Guidelines states:
In addition, although FRAX scores are widely used, there is a lack of evidence linking FRAX scores to treatment efficacy.
Resources:
(1) Final Recommendation Statement Osteoporosis: Screening from The U.S. Preventive Services Task Force Current as of: January 2011.
(2) NOGG 2017: Clinical guideline for the prevention and treatment of osteoporosis [PDF] from The National Osteoporosis Guideline Group.
(3) FRAX ®Fracture Risk Assessment Tool The Fracture Risk Assessment Tool is only available by paid subscription.
(4) 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.
(5) 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
(6) 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.
(7) Osteoporosis: assessing the risk of fragility fracture Clinical guideline [CG146]Published date: August 2012 Last updated: February 2017
(8) Osteoporosis – Quality standard [QS149] Published date: April 2017 from NICE
Other quality standards that should be considered when commissioning or providing osteoporosis services include:
- Menopause (2017) NICE quality standard 143
- Falls in older people (2015, updated 2017) NICE quality standard 86
- Hip fracture in adults (2012, updated 2016) NICE quality standard 16.
A full list of NICE quality standards is available from the quality standards topic library.
(9) Osteoporosis Decision Aid from Mayo Clinic Shared Decision Making National Resource Center. You need to register (free) to use the site.
(10) Evaluating Guidelines: A Review of Key Quality Criteria [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Dtsch Arztebl Int. 2015 Jul 6;112(27-28):471-8. doi: 10.3238/arztebl.2015.0471
(11) Validation and reliability of a guideline appraisal mini-checklist for daily practice use [PubMed Abstract] [Full Text HTML] [Full Text PDF]. BMC Med Res Methodol. 2016 Apr 2;16:39. doi: 10.1186/s12874-016-0139-x.
