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Is Too Much Intervention Recommended in the ACP Osteoporosis Treatment Guidelines?
- Pablo Alonso-Coello, MD;
- Alberto López, MD;
- Laurie J. Pencille, BA; and
- Victor M. Montori, MD, MSc
- From Iberoamerican Cochrane Center, Hospital de la Santa Creu i Sant Pau and CIBER de Epidemiología y Salud Pública (CIBERESP), 08025 Barcelona, Spain; Área IX de Atención Primaria, 28914 Leganés, Spain; and Mayo Clinic, Rochester, MN 55905.
TO THE EDITOR:
We reviewed the American College of Physicians (ACP) guidelines on the treatment of low bone density or osteoporosis to prevent fractures (1). Strengths of these guidelines include their rigorous methods; their use of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach (2); and that they are based on an extensive systematic review. However, we are worried that adherence to these guidelines may not yield the balance of benefits and costs that the authors judged as favorable when they made strong treatment recommendations, and we have a few questions to clarify this issue.
The panel strongly recommended that clinicians offer pharmacologic treatment to everyone with densitometric osteoporosis, as well as those who have experienced fragility fractures. However, they say that “osteoporosis affects an estimated 44 …
