Disparate Outcomes from Applying U.K. and U.S. Osteoporosis Treatment Guidelines

Abstract

After the advent of absolute fracture risk calculators, guidelines for the management of osteoporosis released by the U.S.-based National Osteoporosis Foundation (NOF) and the U.K.-based National Osteoporosis Guidelines Group (NOGG) differ markedly in their approaches to treatment recommendations. The aim of the study was to apply the NOF and NOGG guidelines to a cohort of older women and compare the treatment recommendations with fracture outcomes over 5 yr for each algorithm. We conducted a cohort study of women who participated in a 5-yr randomized controlled trial of calcium supplementation at a clinical research center. We studied 1471 healthy, community-dwelling, older women with mean age of 74 yr and mean follow-up of 4.4 yr. A total of 143 subjects (10%) sustained a nontraumatic osteoporotic fracture, and 21 sustained a nontraumatic hip fracture (1.4%). Applying the NOF guidelines required that 97% of participants undergo bone densitometry and 48% receive treatment. Seventy-six percent of hip fracture cases and 63% of osteoporotic fracture cases were identified for treatment. Applying the NOGG guidelines required that 13% of participants undergo bone densitometry and 21% receive treatment. Thirty-eight percent of hip fracture cases and 27% of osteoporotic fracture cases were identified for treatment. Treatment recommendations and fracture outcomes in older, predominantly osteopenic women differ substantially according to the management guideline applied. The NOGG guidelines identify only a minority of fracture cases; the NOF guidelines identify the majority of fracture cases, but at the expense of greater resource utilization. Both strategies lead to recommendations for reassurance in significant numbers of women who subsequently sustain fragility fractures.