IOF and ESCEO review of ACP guidelines outlines key flaws

osteoporosis international, scientific peer-reviewed journal
Position Statement finds that American College of Physicians guidelines are outdated, due in part to the endorsement of treatment based on T-scores rather than fracture risk assessment, and failure to adequately consider anabolic therapies.

A new review, endorsed by the International Osteoporosis Foundation (IOF) and the European Society of Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), provides a succinct summary of several failings of the recent guidelines of the American College of Physicians (ACP) on the treatment of low bone density and osteoporosis.

> Read ‘Review of the guideline of the American College of Physicians on the treatment of osteoporosis

The ACP guidelines recommend that clinicians offer pharmacological treatment to reduce spine and hip fracture risk in women with osteoporosis, and consider treatment in women at high risk. The recommendations are largely based on a systematic review of randomized controlled trials. Although a review of such evidence is to be commended, IOF and ESCEO find that the ACP guidelines largely ignore other important evidence that might modulate the way guidelines are formulated.

The principle areas of concern are the scope of the guideline, its position on FRAX, the limited duration of therapy (which does not take individual variability into account), and the failure to consider anabolic interventions.

In a previous IOF communication, IOF President Cyrus Cooper stated:

Guidelines issued by US organisations such as the ACP are very influential internationally, and for that reason it is important that any concerns about, or omissions in, such new guidelines are communicated to physicians worldwide. As bone health experts, it’s our responsibility to ensure that primary care physicians – who play such a critical role in osteoporosis and fracture prevention – have accurate and complete information to ensure optimal patient care.”

Reference: Kanis, J.A., Cooper, C., Rizzoli, R. et al. Review of the guideline of the American College of Physicians on the treatment of osteoporosis. Osteoporos Int (2018).

See IOF Statement of May 17, 2017