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16 September 2008 | Volume 149 Issue 6 | Pages 404-415
Description: The American College of Physicians (ACP) developed this guideline to present the available evidence on various pharmacologic treatments to prevent fractures in men and women with low bone density or osteoporosis.
Methods: Published literature on this topic was identified by using MEDLINE (1966 to December 2006), the ACP Journal Club database, the Cochrane Central Register of Controlled Trials (no date limits), the Cochrane Database of Systematic Reviews (no date limits), Web sites of the United Kingdom National Institute of Health and Clinical Excellence (no date limits), and the United Kingdom Health Technology Assessment Program (January 1998 to December 2006). Searches were limited to English-language publications and human studies. Keywords for search included terms for osteoporosis, osteopenia, low bone density, and the drugs listed in the key questions. This guideline grades the evidence and recommendations according to the ACP's clinical practice guidelines grading system.
Recommendation 1: ACP recommends that clinicians offer pharmacologic treatment to men and women who have known osteoporosis and to those who have experienced fragility fractures (Grade: strong recommendation; high-quality evidence).
Recommendation 2: ACP recommends that clinicians consider pharmacologic treatment for men and women who are at risk for developing osteoporosis (Grade: weak recommendation; moderate-quality evidence).
Recommendation 3: ACP recommends that clinicians choose among pharmacologic treatment options for osteoporosis in men and women on the basis of an assessment of risk and benefits in individual patients (Grade: strong recommendation; moderate-quality evidence).
Recommendation 4: ACP recommends further research to evaluate treatment of osteoporosis in men and women.
Author and Article Information
From the American College of Physicians and University of Pennsylvania, Philadelphia, Pennsylvania; Veterans Affairs Greater Los Angeles Healthcare System and RAND, Santa Monica, California; University of Arkansas, Little Rock, Arkansas; and Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, California.
Note: Clinical practice guidelines are "guides" only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Grant Support: Financial support for the development of this guideline comes exclusively from the American College of Physicians' operating budget.
Potential Financial Conflicts of Interest: Employment: R. Hopkins (University of Arkansas). Consultancies: D.K. Owens (GE Healthcare). Grants received: V. Snow (Novo Nordisk, United Healthcare Foundation, Centers for Disease Control and Prevention, Atlantic Philanthropies). Any conflict of interest of the Guideline Development Committee group members was declared, discussed, and resolved.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, aqaseem{at}acponline.org.
Current Author Addresses: Drs. Qaseem and Snow: 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Shekelle: 1776 Main Street, Santa Monica, CA 90401.
Dr. Hopkins: 4301 West Markham Street, Little Rock, AR 72205.
Dr. Forciea: 3615 Chestnut Street, Philadelphia, PA 19104.
Dr. Owens: 117 Encina Commons, Stanford, CA 94305. CLINICAL GUIDELINES
Pharmacologic Treatment of Low Bone Density or Osteoporosis to Prevent Fractures: A Clinical Practice Guideline from the American College of Physicians
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