title: Choice of osteoporosis guideline has important implications for the treatment decision in elderly women referred to a fall clinic.
abstract: BACKGROUND
  Different guidelines are used worldwide to make decisions on treating osteoporosis. Some are based on fracture risk calculations, whereas others use criteria based on bone mineral density (BMD) T-scores, risk factors, or fragility fractures. The aim of this study was to explore how osteoporosis treatment decisions in a group of elderly women with falls would be affected if fracture risk-based guidelines were used as compared to guidelines based on BMD T-scores.
  
  
  METHODS
  We studied 88 women attending a falls clinic. Dual energy X-ray absorptiometry and vertebral fracture assessment were performed and clinical risk factors were identified. We calculated the percentage of women recommended for treatment using five guidelines: Danish Bone Society (DBS-DK), UK National Osteoporosis Guideline Group (NOGG-UK), US National Osteoporosis Foundation (NOF-US); and we applied a 20% cut-off to fracture risk calculations by the Garvan Fracture Risk Calculator and Q-fracture 2012. Agreement was calculated using kappa statistics.
  
  
  RESULTS
  The median age (interquartile range) was 81 years (75-85.5 years). The proportion of women (95% confidence interval) recommended for treatment was DBS-DK 56% (44.7-66.3%), NOGG-UK 51% (40.1-62.1%), NOF-US 88% (78.5-93.5%), Garvan 91% (82.9-96.0%), Q-fracture 58% (47.0-68.4%). The guidelines agreed on treatment recommendations for 23 (26%) of the 88 women studied. The kappa score was 0.13 (p < 0.0001).
  
  
  CONCLUSIONS
  This study showed that the choice of guideline has a major impact on the treatment decisions in elderly women with falls.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  ClinicalTrial.gov (NCT01600547).
authors.affiliation: Geriatrisk Afdeling G, Odense Universitetshospital, Sdr. Boulevard 29, indg. 112, 7., 5000 Odense C, Denmark. katja.thomsen@rsyd.dk.
authors.forename: Katja
authors.initials: K
authors.lastname: Thomsen
authors.forename: Jesper
authors.initials: J
authors.lastname: Ryg
authors.forename: Lars
authors.initials: L
authors.lastname: Matzen
authors.forename: Anne Pernille
authors.initials: AP
authors.lastname: Hermann
authors.forename: Tahir
authors.initials: T
authors.lastname: Masud
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000639:trends; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D050723:Fractures, Bone / Q000628:therapy; D006801:Humans; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000628:therapy*; D057240:Patient Preference; D017410:Practice Guidelines as Topic