CLINICAL-PRACTICE GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF OSTEOPOROSIS

Objective: To recommend clinical practice guidelines for the assessmen t of people at risk for osteoporosis, and for effective diagnosis and management of the condition. Options: Screening and diagnostic methods : risk-factor assessment, clinical evaluation, measurement of bone min eral density, laboratory investigations. Prophylactic and corrective t herapies: calcium and vitamin D nutritional supplementation, physical activity and fall-avoidance techniques, ovarian hormone therapy, bisph osphonate drugs, other drug therapies. Pain-management medications and techniques. Outcomes: Prevention of loss of bone mineral density and fracture; increased bone mass; and improved quality of life. Evidence: Epidemiologic and clinical studies and reports were examined, with em phasis on recent randomized controlled trials. Clinical practice in Ca nada and elsewhere was surveyed. Availability of treatment products an d diagnostic equipment in Canada was considered. Values: Cost-effectiv e methods and products that can be adopted across Canada were consider ed. A high value was given to accurate assessment of fracture risk and osteoporosis, and to increasing bone mineral density, reducing fractu res and fracture risk and minimizing side effects of diagnosis and tre atment. Benefits, harms and costs: Proper diagnosis and management of osteoporosis minimize injury and disability, improve quality of life f or patients and reduce costs to society. Rationally targeted methods o f screening and diagnosis are safe and cost effective. Harmful side ef fects and costs of recommended therapies are minimal compared with the harms and costs of untreated osteoporosis. Alternative therapies prov ide a range of choices for physicians and patients. Recommendations: P opulation sets at high risk should be identified and then the diagnosi s confirmed through bone densitometry. dual-energy x-ray absorptiometr y is the preferred measurement technique. Radiography can be an adjunc t when indicated. Calcium and vitamin D nutritional supplementation sh ould be at currently recommended levels. Patients should be counselled in fall-avoidance techniques and exercises. Immobilization should be avoided. Guidelines for management of acute pain an listed. Ovarian ho rmone therapy is the therapy of choice for osteoporosis prevention and treatment in postmenopausal women. Bisphosphonates are an alternative therapy for women with established osteoporosis who cannot or prefer not to take ovarian hormone therapy. Validation: These guidelines were reviewed and approved by the Scientific Advisory Board of the Osteopo rosis Society of Canada, in consultation with individual family and ge neral practitioners. Sponsors: These guidelines are based on the conse nsus statements on osteoporosis prevention and management, published b y the Scientific Advisory Board of the Osteoporosis Society of Canada in 1996. Sponsors of this publication are Procter & Gamble Pharmaceuti cals Canada Inc., Eli Lilly Canada, Inc., Wyeth-Ayerst Canada Inc., Me rck Frosst Canada Inc. and the Dairy Bureau of Canada.