Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan.
Department of Medicine, Aga Khan University, Karachi, Pakistan.
Arch Osteoporos. 2023 May 19;18(1):71. doi: 10.1007/s11657-023-01258-2.
Due to its high prevalence, we aimed to create postmenopausal osteoporosis clinical practice guideline via GRADE-ADOLOPMENT for Pakistan. We recommend a higher dose (2000-4000 IU) of vitamin D for osteoporotic patients who are old, have malabsorption, or are obese. The guideline will help standardize care provision and improve health care outcomes for osteoporosis.
Postmenopausal osteoporosis affects one in every five postmenopausal women in Pakistan. An evidence-based clinical practice guideline (CPG) is needed to standardize care provision to optimize health outcomes. Hence, we aimed to develop CPG for the management of postmenopausal osteoporosis in Pakistan.
The GRADE-ADOLOPMENT process was used to adopt (as is or with minor changes), exclude (omit), or adapt (modify based on local context) recommendations to the source guideline (SG)-clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update from American Association of Clinical Endocrinology (AACE).
The SG was "adoloped" to cater to the local context. The SG consisted of 51 recommendations. Forty-five recommendations were adopted as is. Due to unavailability of drugs, 4 recommendations were adopted with minor changes, and one was excluded, while one recommendation was adopted with the inclusion of use of a surrogate FRAX tool specific for Pakistan. One recommendation regarding vitamin D dosage was adapted to recommend a dose of 2000-4000 IU of vitamin D in patients with obesity, malabsorption, and old age.
The developed Pakistani postmenopausal osteoporosis guideline consists of 50 recommendations. The guideline created recommends a higher dose (2000-4000 IU) of vitamin D for patients who are old, have malabsorption, or are obese, which is an adaptation from the SG by the AACE. This higher dose is justified as lower doses prove to be suboptimal in these groups and should be complemented with baseline vitamin D and calcium levels.
绝经后骨质疏松症影响了巴基斯坦每五名绝经后妇女中的一名。需要制定循证临床实践指南 (CPG) 来规范护理提供，以优化骨质疏松症的健康结果。因此，我们旨在为巴基斯坦绝经后骨质疏松症的管理制定 CPG。
使用 GRADE-ADOLOPMENT 过程采用（原样或稍加修改）、排除（省略）或改编（根据当地情况修改）源指南（SG）-美国临床内分泌医师协会（AACE）2020 年更新的绝经后骨质疏松症诊断和治疗临床实践指南中的建议。
SG 被“改编”以适应当地情况。SG 由 51 条建议组成。45 条建议原样采用。由于药物不可用，4 条建议稍加修改采用，1 条建议被排除，1 条建议被采用，并纳入了针对巴基斯坦的特定替代 FRAX 工具的使用。关于维生素 D 剂量的 1 条建议被改编为建议在肥胖、吸收不良和老年患者中使用 2000-4000 IU 的维生素 D。
制定的巴基斯坦绝经后骨质疏松症指南包含 50 条建议。该指南建议肥胖、吸收不良和老年患者使用更高剂量（2000-4000 IU）的维生素 D，这是对 AACE 的 SG 的改编。这种更高的剂量是合理的，因为较低的剂量在这些人群中证明是不充分的，并且应该与基线维生素 D 和钙水平相补充。
