Cheung Elaine, Kung Annie W C, Tan Kathryn C B
Department of Medicine, United Christian Hospital, Hong Kong, China.
Clin Endocrinol (Oxf). 2014 Feb;80(2):200-7. doi: 10.1111/cen.12322. Epub 2013 Oct 10.
We applied the NOF (National Osteoporosis Foundation, USA), NOGG (National Osteoporosis Guideline Group, UK) and Taiwanese guidelines to a cohort of postmenopausal women and compared the effectiveness in fracture prevention according to these guidelines.
This study is part of the Hong Kong Osteoporosis Study in which postmenopausal women underwent regular assessment and followed up for fracture outcome.
We studied 2266 treatment-naïve postmenopausal women with mean age of 62·1 years and mean follow-up of 4·5 years.
The treatment recommendations based on different guidelines were compared. The women were followed up to determine the rate of fracture occurrence.
A total of 106 new major osteoporotic fractures (MOF) were reported, of which 21 were hip fractures (HF). Application of the NOF, NOGG and Taiwanese guidelines resulted in bone mineral density (BMD) screening of 40·7%, 1·3% and 31·8% and treatment of 26·8%, 15·5% and 25·4% of the cohort, respectively. 85·7%, 52·4% and 85·7% of the subjects who sustained HFs would be offered treatment according to the NOF, NOGG and Taiwanese guidelines, respectively. Likewise, 58·5%, 34% and 59·4% of the subjects who sustained MOF would be offered treatment according to the 3 guidelines, respectively. The clinical utility indexes for the 3 guidelines based on the occurrence of MOF during follow-up were 0·0597, 0·0345 and 0·0651, respectively. The corresponding numbers for HFs were even lower.
The clinical utility for these three guidelines is low for this postmenopausal cohort. Specific guidelines should be needed to guide BMD screening and treatment in our society.
