Recommendations for the diagnosis and management of osteoporosis

Abstract

LettersRecommendations for the diagnosis and management of osteoporosis Abdullah AlkhenizanCCFP ABHPM DCEpid Abdullah Alkhenizan Search for more papers by this author Published Online:7 Oct 2004https://doi.org/10.5144/0256-4947.2004.396SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: I read with interest the recommendations for the diagnosis and management of osteoporosis by Hussein Raef et al published in the July/August 2004 issue. I have several concerns about the methodology used in the synthesis of these recommendations. First, the authors did not provide any systematic method for searching the literature, which makes these recommendations prone to bias in the selection of included studies. In addition, the authors did not provide any description of included and excluded studies. Second, there is no linkage of the recommendations to their level of evidence. This issue is a key feature of high quality Clinical Practice Guidelines (CPGs), as recommendations that are based on expert opinion are not as valid as recommendations based on level 1 evidence.1 It has been shown that when health care providers accept and follow CPGs, they have the potential to improve both the process of care and patient health outcomes.2,3 However, concerns about the quality of guidelines might limit their acceptance and application by health care providers.4 The cost and resources needed for the development of CPGs is huge and few practices have the resources and skills to develop valid high quality guidelines.5 The overall cost can be considerably reduced if guideline developers “locally adapt” high quality guidelines as a basis for producing their own guideline. There is a growing recognition that national guideline developers do not need to duplicate efforts and waste resources in the development of CPGs. Several developed countries (e.g., New Zealand, Germany and Iceland) encourage local adaptation of international good quality guidelines to avoid duplication of work and cost involved in guidelines development. Local adaptation of CPGs addresses local clinical issues and circumstances and gives a sense of ownership of the clinical guidelines. The Guideline International Network (GIN) suggested a comprehensive methodology for the local adaptation of clinical guidelines.6 There are several high quality osteoporosis guidelines that follow high methodological standards available in the literature.7,8 If the authors tried to “locally adapt” these high quality guidelines they would save significant time and resources, and they would produce a much more useful guidelines for practitioners in Saudi Arabia. This is not limited to osteoporosis guidelines; wherever possible, all Saudi guideline developers should work on the local adaptation of existing good quality guidelines.No Conflict of InterestARTICLE REFERENCES:1. Woolf S, Battista R, Anderson G, Logan AG, Wang E. members of the Canadian Task Force on the Periodic Health Examination. "Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations: a report by the Canadian Task Force on the Periodic Health Examination" . J Clin Epidemiol. 1990; 43:891-905. Google Scholar2. Grimshaw J, Rusell I. "Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations" . Lancet. 1993; 242:1317-1322. Google Scholar3. Steinhoff MS, Abd El Khalek MK, Khallaf N, et al. "Effectiveness of clinical guidelines for the presumptive treatment of streptococcal pharyngitis in Egyptian children" . Lancet. 1997; 350:918-921. Google Scholar4. Helwig A, Bower D, Wolff M, Guse C. "residents find clinical practice guidelines valuable as educational and clinical tools" . Fam Med. 1998; 30(6):431-435. Google Scholar5. Grimshaw J, Eccles M. "Identifying and using evidence-based guidelines in genral practice" . In: Silagy C, Haines A. Evidence-based practice in primary care. London: BMJ Books; 2001;120-134. Google Scholar6. The Guideline International Network (GIN) website http://www.g-l-n.net. Google Scholar7. Brown J, Josse R. for the Scientific Advisory Council of the Osteoporosis Society of Canada. "2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada" . CMAJ. 2002; 167(10 suppl). Google Scholar8. Scottish Intercollegiate Guidelines Network. Management of Osteoporosis: A national clinical guidelineJune2003. http://www.sign.ac.uk/pdf/sign71.pdf. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 24, Issue 5September-October 2004 Metrics History Published online7 October 2004 InformationCopyright © 2004, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download