Skip to main content

Advertisement

SpringerLink
Log in

Review of guidelines for bone mineral density testing and treatment of osteoporosis

  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Clinical practice guidelines (CPGs) are systematically developed statements intended to influence the behavior of health care providers and improve patient care. There are many CPGs with recommendations for selection of patients for bone mineral density testing and pharmacologic treatment of osteoporosis. Health care provider adherence rates for these CPGs are low. The multiplicity of osteoporosis CPGs directed to the same health care providers may play a role in their limited utilization in clinical practice. Similarities, differences, and conflicts in osteoporosis CPGs with wide distribution in the United States were examined. The analysis showed similarities as well as substantial variation in the patient populations addressed, inconsistency of some recommendations, differences in clinical risk factors identified, and sometimes limitations in clinical applications. If the number and diversity of osteoporosis CPGs is adversely affecting their use in clinical practice, then collaboration of stakeholder organizations to develop more consistent CPGs, in combination with systems-based approaches for their implementation, may improve patient care and reduce the burden of osteoporotic fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Field JB, Lohr KN, eds: Clinical Practice Guidelines: Directions for a New Program. Committee to Advise the Public Health Service on Clinical Practice. Washington, DC: National Academic Press; 1990.

    Google Scholar 

  2. Hayward RS, Wilson MC, Tunis SR, et al.: Users’ guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? The Evidence-Based Medicine Working Group. JAMA 1995, 274:570–574.

    Article  PubMed  CAS  Google Scholar 

  3. O’Brien JA, Jr., Jacobs LM, Pierce D: Clinical practice guidelines and the cost of care. A growing alliance. Int J Technol Assess Health Care 2000, 16:1077–1091.

    Article  PubMed  Google Scholar 

  4. Littlejohns P, Cluzeau F: Guidelines for evaluation. Fam Pract 2000, 17(Suppl 1):S3-S6.

    Article  PubMed  Google Scholar 

  5. The AGREE Collaboration: Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. http:// www.agreecollaboration.org. Accessed March 21, 2005.

  6. AGREE Collaboration: Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care 2003, 12:18–23.

    Article  Google Scholar 

  7. Graham ID, Calder LA, Hebert PC, et al.: A comparison of clinical practice guideline appraisal instruments. Int J Technol Assess Health Care 2000, 16:1024–1038.

    Article  PubMed  CAS  Google Scholar 

  8. Shekelle PG, Woolf SH, Eccles M, Grimshaw J: Clinical guidelines: developing guidelines. BMJ 1999, 318:593–596.

    PubMed  CAS  Google Scholar 

  9. Woolf SH, Grol R, Hutchinson A, et al.: Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999, 318:527–530.

    PubMed  CAS  Google Scholar 

  10. Kohn R, Saxena S, Levav I, Saraceno B: The treatment gap in mental health care. Bull World Health Organ 2004, 82:858–866.

    PubMed  Google Scholar 

  11. Ndoye NF, Sow AD, Diop AG, et al.: Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study. Seizure 2005, 14:106–111.

    Article  PubMed  CAS  Google Scholar 

  12. James P, Tan HH, MacAlpine R, et al.: Treatment gap in the use of lipid-lowering drug therapy in diabetes: a populationbased study. Diabet Med 2004, 21:1108–1112.

    Article  PubMed  CAS  Google Scholar 

  13. Andrade SE, Gurwitz JH, Field TS, et al.: Hypertension management: the care gap between clinical guidelines and clinical practice. Am J Manag Care 2004, 10:481–486.

    PubMed  Google Scholar 

  14. El-Jack S, Kerr A: Secondary prevention in coronary artery disease patients in South Auckland: moving targets and the current treatment gap. N Z Med J 2003, 116:U664.

    PubMed  Google Scholar 

  15. Feldstein A, Elmer PJ, Orwoll E, et al.: Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures-a gap in evidence-based practice guideline implementation. Arch Intern Med 2003, 163:2165–2172.

    Article  PubMed  Google Scholar 

  16. Feldstein AC, Nichols GA, Elmer PJ, et al.: Older women with fractures: patients falling through the cracks of guideline-recommended osteoporosis screening and treatment. J Bone Joint Surg Am 2003, 85A:2294–2302.

    Google Scholar 

  17. Andrade SE, Majumdar SR, Chan KA, et al.: Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 2003, 163:2052–2057.

    Article  PubMed  Google Scholar 

  18. Panneman MJ, Lips P, Sen SS, Herings RM: Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int 2004, 15:120–124.

    Article  PubMed  Google Scholar 

  19. Kiebzak GM, Beinart GA, Perser K, et al.: Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 2002, 162:2217–2222.

    Article  PubMed  Google Scholar 

  20. Gallagher TC, Geling O, Comite F: Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med 2002, 162:450–456.

    Article  PubMed  Google Scholar 

  21. Harrington JT, Broy SB, Derosa AM, et al.: Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum 2002, 47:651–654.

    Article  PubMed  Google Scholar 

  22. Juby AG, De Geus-Wenceslau CM: Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int 2002, 13:205–210.

    Article  PubMed  CAS  Google Scholar 

  23. Simonelli C, Killeen K, Mehle S, Swanson L: Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc 2002, 77:334–338.

    PubMed  Google Scholar 

  24. Kaufman JD, Bolander ME, Bunta AD, et al.: Barriers and solutions to osteoporosis care in patients with a hip fracture. J Bone Joint Surg Am 2003, 85A:1837–1843.

    Google Scholar 

  25. Hodgson SF, Watts NB, Bilezikian JP, et al.: American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 2003, 9:544–564.

    PubMed  Google Scholar 

  26. The Writing Group for the International Society for Clinical Densitometry Position Development Conference 2004: International Society for Clinical Densitometry Position Development Conference. Indications and reporting for dual-energy x-ray absorptiometry. J Clin Densitom 2004, 7:37–44.

    Article  Google Scholar 

  27. North American Menopause Society: Management of postmenopausal osteoporosis: position statement of the North American Menopause Society: Menopause 2002, 9:84–101.

    Google Scholar 

  28. Klibanski A, Adams-Campbell L, Bassford T, et al.: Osteoporosis prevention, diagnosis, and therapy. JAMA 2001, 285:785–795.

    Article  Google Scholar 

  29. National Osteoporosis Foundation: Physician’s guide to prevention and treatment of osteoporosis. Washington, D.C: National Osteoporosis Foundation; 2003.

    Google Scholar 

  30. US Preventive Services Task Force: Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med 2002, 137:526–528.

    Google Scholar 

  31. Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Introduction. Osteoporos Int 1998, 8(Suppl 4):S7–80.

  32. Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Executive summary. Osteoporos Int 1998, 8(Suppl 4):S3–S6.

  33. Saha S, Hoerger TJ, Pignone MP, et al.: The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. Am J Prev Med 2001, 20(Suppl 3):36–43.

    Article  PubMed  CAS  Google Scholar 

  34. Boggs PP, Utian WH: The North American Menopause Society develops consensus opinions. Menopause 1998, 5:67–68.

    PubMed  CAS  Google Scholar 

  35. Harris RP, Helfand M, Woolf SH, et al.: Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med 2001, 20(Suppl 3):21–35.

    Article  PubMed  CAS  Google Scholar 

  36. Solomon DH, Brookhart MA, Gandhi TK, et al.: Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med 2004, 117:919–924. A study of variables associated with adherence to local osteoporosis guidelines with 6311 at-risk patients seen by 160 physicians at 10 practice sites associated with an academic medical center.

    Article  PubMed  Google Scholar 

  37. World Health Organization: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: WHO; 1994.

    Google Scholar 

  38. Kanis JA, Johnell O, Oden A, et al.: Intervention thresholds for osteoporosis. Bone 2002, 31:26–31.

    Article  PubMed  CAS  Google Scholar 

  39. Kanis JA, Borgstrom F, Zethraeus N, et al.: Intervention thresholds for osteoporosis in the UK. Bone 2005, 36:22–32.

    Article  PubMed  Google Scholar 

  40. Kanis JA, Oden A, Johnell O, et al.: The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 2001, 12:417–427.

    Article  PubMed  CAS  Google Scholar 

  41. Kanis JA, Black D, Cooper C, et al.: A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 2002, 13:527–536.

    Article  PubMed  CAS  Google Scholar 

  42. Morris CA, Cabral D, Cheng H, et al.: Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med 2004, 19:783–790. A systematic review of 24 guidelines for BMD testing, 22 studies of BMD testing rates, and five interventions designed to increase BMD testing rates.

    Article  PubMed  Google Scholar 

  43. Solomon DH, Morris C, Cheng H, et al.: Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc 2005, 80:194–202. A review of 18 guidelines for osteoporosis treatment, 18 studies of treatment rates in patients with fractures, 17 analyses of patient and/ or physician factors associated with osteoporosis treatment, and eight studies examining interventions to improve osteoporosis treatment.

    Article  PubMed  Google Scholar 

  44. US Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General; 2004.

    Google Scholar 

  45. Cummings SR, Nevitt MC, Browner WS, et al.: Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995, 332:767–773.

    Article  PubMed  CAS  Google Scholar 

  46. De Laet CE, Van Hout BA, Burger H, et al.: Hip fracture prediction in elderly men and women: validation in the Rotterdam study. J Bone Miner Res 1998, 13:1587–1593.

    Article  PubMed  Google Scholar 

  47. Cadarette SM, Jaglal SB, Kreiger N, et al.: Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. Can Med Assoc J 2000, 162:1289–1294.

    CAS  Google Scholar 

  48. Lydick E, Cook K, Turpin J, et al.: Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 1998, 4:37–48.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, 87106, Albuquerque, NM, USA

    E. Michael Lewiecki MD, FACP

Authors
  1. E. Michael Lewiecki MD, FACP
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lewiecki, E.M. Review of guidelines for bone mineral density testing and treatment of osteoporosis. Curr Osteoporos Rep 3, 75–83 (2005). https://doi.org/10.1007/s11914-005-0014-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11914-005-0014-x

Keywords

Search

Navigation