Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology

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Abstract

Background

The Italian Society for Orthopaedics and Traumatology conceived this guidance—which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners—in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences.

Materials and methods

Literature reviews by a multidisciplinary team.

Results

The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1–3). Toolboxes for everyday clinical practice are provided.

Conclusions

The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.

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Most cited references 131

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Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.

(1993)

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Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis.

C M Klotzbuecher, P. D. Ross, P B Landsman … (2000)

Numerous studies have reported increased risks of hip, spine, and other fractures among people who had previous clinically diagnosed fractures, or who have radiographic evidence of vertebral fractures. However, there is some variability in the magnitudes of associations among studies. We summarized the literature and performed a statistical synthesis of the risk of future fracture, given a history of prior fracture. The strongest associations were observed between prior and subsequent vertebral fractures; women with preexisting vertebral fractures (identified at baseline by vertebral morphometry) had approximately 4 times greater risk of subsequent vertebral fractures than those without prior fractures. This risk increases with the number of prior vertebral fractures. Most studies reported relative risks of approximately 2 for other combinations of prior and future fracture sites (hip, spine, wrist, or any site). The confidence profile method was used to derive a single pooled estimate from the studies that provided sufficient data for other combinations of prior and subsequent fracture sites. Studies of peri- and postmenopausal women with prior fractures had 2.0 (95 % CI = 1.8, 2.1) times the risk of subsequent fracture compared with women without prior fractures. For other studies (including men and women of all ages), the risk was increased by 2.2 (1.9, 2.6) times. We conclude that history of prior fracture at any site is an important risk factor for future fractures. Patients with a history of prior fracture, therefore, should receive further evaluation for osteoporosis and fracture risk.

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European guidance for the diagnosis and management of osteoporosis in postmenopausal women

J Kanis, E. McCloskey, H. Johansson … (2012)

Summary Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk of fractures due to osteoporosis. Introduction The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2008. This manuscript updates these in a European setting. Methods Systematic literature reviews. Results The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk, general and pharmacological management of osteoporosis, monitoring of treatment, assessment of fracture risk, case finding strategies, investigation of patients and health economics of treatment. Conclusions A platform is provided on which specific guidelines can be developed for national use.

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Author and article information

Contributors

Maria Luisa Brandi: +39 055 7946304 , marialuisa.brandi@unifi.it

Journal

Journal ID (nlm-ta): J Orthop Traumatol

Journal ID (iso-abbrev): J Orthop Traumatol

Title: Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1590-9921

ISSN (Electronic): 1590-9999

Publication date (Electronic): 20 October 2017

Publication date PMC-release: 20 October 2017

Publication date (Print): November 2017

Volume: 18

Issue: Suppl 1

Pages: 3-36

Affiliations

[1 ]ISNI 0000 0001 2300 0941, GRID grid.6530.0, Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, , University of Rome Tor Vergata, ; Rome, Italy

[2 ]ISNI 0000 0001 2200 8888, GRID grid.9841.4, Department of Medical and Surgical Specialties and Dentistry, , Second University of Naples, ; Naples, Italy

[3 ]ISNI 0000 0004 1757 2304, GRID grid.8404.8, Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, , University of Florence, ; Viale Pieraccini, 6, 50139 Florence, Italy

[4 ]ISNI 0000 0001 2300 0941, GRID grid.6530.0, Nursing Science, Center of Excellence for Culture and Nursing Research—IPASVI, , University of Rome Tor Vergata, ; Rome, Italy

[5 ]Section of Orthopaedics and Traumatology, Centre for the Study of Osteoporosis and Metabolic Bone Disease, Treviglio-Caravaggio Hospital, Bergamo, Italy

Article

Publisher ID: 474

DOI: 10.1007/s10195-017-0474-7

PMC ID: 5688964

PubMed ID: 29058226

SO-VID: a7a2c19d-5e5a-41b1-b3eb-32cc3b57201f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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ScienceOpen disciplines: Orthopedics

Keywords: fracture,fracture liaison service,guidance,bisphosphonates,denosumab,teriparatide,strontium ranelate

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ScienceOpen disciplines: Orthopedics

Keywords: fracture, fracture liaison service, guidance, bisphosphonates, denosumab, teriparatide, strontium ranelate

Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology

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Abstract

Background

Materials and methods

Results

Conclusions

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Orthopedics

Most cited references 131

Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.

Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis.

European guidance for the diagnosis and management of osteoporosis in postmenopausal women

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