title: Osteoporosis Management in a Real Clinical Setting: Heterogeneity in Intervention Approach and Discrepancy in Treatment Rates when Compared with the NOGG and NOF Guidelines.
abstract: Objective:The National Osteoporosis Guideline Group (NOGG) proposes intervention thresholds that vary by age. Instead, the National Osteoporosis Foundation (NOF) proposes a fixed threshold for decision. The aim of the present study was to compare the actual therapeutic decisions taken in a routine clinical practice setting with those recommended by the NOF and NOGG guidelines.Material and methods:A cross-sectional study was conducted in individuals referred to a densitometric unit who were not receiving antiresorptive therapy. The absolute risk of major and hip fracture was calculated using the British formula provided by the FRAX®tool. NOGG and NOF guidelines' therapeutic intervention thresholds were used. Agreement was calculated using Cohen's kappa.Results:A total of 640 individuals were included, of which 95% were women, with a median age of 59.4 (IQR=14) years. 31.7% of subjects who were analyzed received treatment for osteoporosis. The type of treatment that was mainly prescribed (71.9%) consisted of bisphosphonates. When applying the NOGG criteria, treatment was recommended in 22.7% of cases; this percentage increased to 42.2% with the NOF guidelines. According to both guidelines, 20.4% of patients would not have received treatment. The concordance, expressed as the kappa index, was low; 0.25 (CI 95% 0.17-0.34) and 0.49 (CI 95% 0.42-0.55), with the NOGG and NOF, respectively.Conclusions:Important heterogeneity exists in the treatment of osteoporosis in real practice. The choice of guideline has a major impact on the proportion and selection of individuals recommended for treatment and, subsequently, on treatment-related expenditures.
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Kyriakos
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Vidal-Casariesgo
authors.affiliation: Health Center Jesús Marín, Molina de Segura, Murcia, Spain.
authors.forename: L V
authors.initials: LV
authors.lastname: Quiles-Sánchez
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Urosa-Maggi
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Calleja-Fernández
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Hernández-Moreno
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: M D
authors.initials: MD
authors.lastname: Ballesteros-Pomar
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Cano-Rodriguez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000191:economics / Q000628:therapy*; D017410:Practice Guidelines as Topic