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Pharmacologic therapy to reduce fracture risk: comment on the clinical practice guidelines of the ACP

Nature Reviews Rheumatology volume 5, pages 120–121 (2009)Cite this article

Osteoporosis is a skeletal disease that is characterized by reduced bone strength and increased risk of fracture,1 and has been identified as a major public health concern associated with serious clinical consequences and high health-care costs.2 Despite the availability of excellent tools for diagnosing osteoporosis and the development of many therapeutic agents proven to reduce the risk of fracture, the disease remains underdiagnosed and undertreated.2 Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances”.3 Good clinical practice guidelines that improve patient outcomes are based on high-quality evidence, are widely distributed to the target population, and are actually used by clinicians. Guidelines that are not used in clinical practice offer no benefit, regardless of the quality of the evidence on which they are based.

Many clinical practice guidelines for osteoporosis have been developed to help clinicians select patients who are most likely to benefit from drug therapy to reduce fracture risk;4 however, differences in bone mineral density (BMD) thresholds, clinical risk factors and applicable patient populations have lead to heterogeneity of these recommendations that might serve to confuse rather than enlighten.5 In 2008, the American College of Physicians (ACP) published its guidelines for the pharmacologic treatment of low BMD and osteoporosis in men and women to reduce fracture risk (Supplementary Box 1 online).6 This article provides a commentary on these guidelines, with particular regard to their benefits and limitations in the context of the National Osteoporosis Foundation (NOF) Clinician's Guide to the Prevention and Treatment of Osteoporosis,7 the WHO fracture risk assessment tool (FRAX™)8 and the Official Positions of the International Society for Clinical Densitometry (ISCD).9

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References

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Author notes

  1. New Mexico Clinical Research and Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA lewiecki@aol.com

Authors and Affiliations

  1. EM Lewiecki is Clinical Assistant Professor of Medicine at the University of New Mexico School of Medicine and Osteoporosis and Director of the New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.,

    E Michael Lewiecki

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  1. E Michael Lewiecki
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Competing interests

The author has received grant/research support (principal investigator, funding to New Mexico Clinical Research & Ostoeoporosis Center) from Amgen, Eli Lilly, Novartis, GSK, Pfizer, Procter & Gamble, Roche, Sanofi Aventis, and Wyeth, has received speakers' bureau or scientific advisory board honoraria from Amgern, Eli Lilly, Novartis, Roche, GSK, Upsher-Smith, Wyeth, and is a direct stock shareholder in General Electric, Proctor & Gamble, and Teva.

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Lewiecki, E. Pharmacologic therapy to reduce fracture risk: comment on the clinical practice guidelines of the ACP. Nat Rev Rheumatol 5, 120–121 (2009). https://doi.org/10.1038/ncprheum1024

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