Choice of osteoporosis guideline has important implications for the treatment decision in elderly women referred to a fall clinic

Abstract

Introduction: 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).

Conclusion: This study showed that the choice of guideline has a major impact on the treatment decisions in elderly women with falls.

Funding: not relevant.

Trial registration: ClinicalTrial.gov (NCT01600547).