title: Expert Consensus on the Management of Patients with Postmenopausal Osteoporosis in the Spanish Healthcare System.
abstract: The management of postmenopausal osteoporosis (PMO) in routine clinical practice differs considerably from guideline recommendations. The objective of our study was to reach a consensus on the management of PMO, considering prevention, diagnosis, treatment and follow-up, according to expert opinion in Spain.
  
  
  
  A two-round Delphi technique was conducted, including 38 experts. The questionnaire contained 35 sections, each one including 1-10 questions (n = 308) based on a literature review and contributions from the scientific steering committee. Each question was scored by experts from the current (1 = no occurrence, 9 = occurrence in all cases), wish (1 = total rejection; 9 = wish) and prediction (1 = no occurrence at all; 9 = occurs with maximum probability) perspectives. Consensus (wish and prediction perspectives) was considered when ≥75% of experts scored 7-9 (agreement) or 1-3 (disagreement).
  
  
  
  Overall, consensus was achieved on 75% of questions. While protocols of clinical management and consultation/referral should be followed, their implementation is unlikely. Furthermore, the medical specialties currently involved in PMO management are poorly defined. PMO patients without fracture should be managed (prevention, diagnosis, treatment and follow-up) in both primary care and rheumatology settings; however, experts predicted that only treatment and follow-up will be assumed by these specialties. A multidisciplinary team should be involved in patients with fracture. No assessment tools are usually applied, and prediction indicated that they will not be used.
  
  
  
  Efforts should be focused on questions with high divergence between wishes and predictions, defining actions that will improve PMO management. Collaboration between scientific societies and health authorities to address the identified opportunities of improvement is proposed.
  
  
  
  Amgen S.A.
authors.affiliation: Servicio de Reumatología; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III FEDER, Salamanca, Spain. jpino@usal.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Del Pino-Montes
authors.affiliation: Servicio de Reumatología, Hospital del Mar, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Blanch
authors.affiliation: Servicio de Medicina Interna; IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III FEDER, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Nogués
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Moro
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: María Del Carmen
authors.initials: Mdel C
authors.lastname: Valero
authors.affiliation: Amgen S.A., Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Canals
authors.affiliation: Outcomes'10, Universitat Jaume I, Castellón, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Lizán
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003245:Consensus Statements as Topic; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D010346:Patient Care Management / Q000379:methods / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Consensus; Delphi; Postmenopausal osteoporosis; Rheumatology