Guidelines for the diagnosis of osteoporosis by densitometric methods

Abstract

Background: Osteoporosis is a major health hazard for postmenopausal women and elderly people. Local, national, and international organizations developed clinical practice guidelines for the diagnosis and management of osteoporosis and the prevention of osteoporotic fractures. Low bone mineral density (BMD) is the most important risk factor for fragility fractures. Bone densitometry is the best method to measure BMD in an individual. Many risk factors contribute to the development of osteoporosis and increase the fracture risk independently from BMD. Guidelines must be comprehensive, factual, simple to implement, and should provide the clinician, patients, governments, and payers with the best evidence available. Objectives: The objectives of this article were to review national and international guidelines to establish a congruent set of parameters that may aid the clinician in the decision-making process for the diagnosis of osteoporosis. Data Sources: An online search of several databases provided 18 guidelines for this review. Comparison among the guidelines was made on 10 different aspects: format, focus, significance of hip and vertebral body fractures, primary diagnostic considerations, BMD measurement technology, interpretation, reporting and follow-up, equipment reliability and quality control, risk factors considered, and methodologic quality of the guidelines. Tables were created for easier comparison on the aspects covered and supported by each guideline. Results: None of the guidelines reviewed fulfills all the requirements of good clinical practice guidelines. Conclusions: Further works should finally provide all those interested with a more complete and thorough set of guidelines based on the best evidence available. (J Manipulative Physiol Ther 2002;25:403-15)