Best Practice & Research Clinical Rheumatology
Volume 23, Issue 6 , Pages 711-726 , December 2009

How to decide who to treat

  • J.A. Kanis, MD, FRCP, FRCPath (Emeritus professor)

      Affiliations

    • WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 114 285 1109; Fax: +44 114 285 1813.
  • ,
  • E.V. McCloskey, MD, FRCP (Reader)

      Affiliations

    • WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
    • Osteoporosis Centre, Northern General Hospital, Sheffield, UK
  • ,
  • H. Johansson, MSc (Statistician)

      Affiliations

    • WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
  • ,
  • O. Strom, PhD (Health Economist)

      Affiliations

    • WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
  • ,
  • F. Borgstrom, PhD (Health Economist)

      Affiliations

    • WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK
  • ,
  • A. Oden, PhD (Statistician)

      Affiliations

    • WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK

References 

  1. Delmas PD. Treatment of postmenopausal osteoporosis. Lancet. 2002;359:2018–2026
  2. Boonen S, Body JJ, Boutsen Y, et al. Evidence-based guidelines for the treatment of postmenopausal osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int. 2005;16:239–254
  3. Kanis JA, on behalf of the World Health Organization Scientific Group . Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre. UK: University of Sheffield; 2008;
  4. World Health Organization . Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical Report Series, 843. Geneva: WHO; 1994;
  5. Riggs BL, Melton LJ. The prevention and treatment of osteoporosis. New Engl J Med. 1992;327:620–627
  6. Kanis JA. Use of calcium in the management of osteoporosis. Bone. 1999;24:279–290
  7. Johnell O, Stenbeck M, Rosen M, et al. Therapeutic strategies in the prevention of hip fracture with drugs affecting bone metabolism. Bone. 1993;14(supp 1):85–87
  8. Marshall DA, Sheldon TA, Jonsson E. Recommendations for the application of bone density measurement. Int J Technol Assess Health Care. 1997;13:411–419
  9. Pitt FA, Lloyd-Jones M, Brazier JE, et al. The costs and benefits of screening for and preventing osteoporosis in Trent Region: a report of the Trent Regional Osteoporosis Working Party. Trent Health (UK). 1990;
  10. Swedish Council on Technology Assessment in Health Care (SBU) . Bone density measurement - a systematic review. J Intern Med. 1997;(Suppl 739):241
  11. Cummings SR, Black D. Should perimenopausal women be screened for osteoporosis?. Ann Int Med. 1986;104:817–823
  12. Ott S. Should women get screening bone mass measurements?. Ann Int Med. 1986;104:874–876
  13. Melton LJ, Eddy DM, Johnston CC. Screening for osteoporosis. Ann Intl Med. 1990;112:516–528
  14. Kanis JA. Screening for postmenopausal osteoporosis. A review for the Department of Health, London. 1992.
  15. Royal College of Physicians . Osteoporosis: clinical guidelines for the prevention and treatment. London: Royal College of Physicians; 1999;
  16. Royal College of Physicians and Bone and Tooth Society of Great Britain . Update on pharmacological interventions and an algorithm for management 2000. London UK: Royal College of Physicians; 2000;
  17. European Community. Report on osteoporosis in the European Community. Strasbourg, EC, 1998
  18. Kanis JA, Johnell O, Oden A, et al. Ten-year risk of osteoporotic fracture and the effects of risk factors on screening strategies. Bone. 2002;30:251–258
  19. World Health Organization . Prevention and management of osteoporosis. WHO Technical Report Series, No 921. Geneva: WHO; 2003;
  20. Barrett-Connor E, Gore R, Browner WS, Cummings SR. Prevention of osteoporotic hip fracture: global versus high-risk strategies. Osteoporos Int. 1998;8(Suppl 1):S2–S7
  21. Torgerson DJ, Thomas RE, Campbell MK, Reid DM. Randomized trial of osteoporosis screening. Arch Int Med. 1997;157:2121–2125
  22. Black D. Why elderly women should be screened and treated to prevent osteoporosis. Am J Med. 1995;98(suppl 2A):67S–75S
  23. Kanis JA, Dawson A, Oden A, et al. Cost-effectiveness of preventing hip fracture in the general female population. Osteoporos Int. 2001;12:356–361
  24. Torgerson DJ, Kanis JA. Cost-effectiveness of preventing hip fractures in the elderly population using vitamin D and calcium. Quart J Med. 1995;88:135–139
  25. National Osteoporosis Foundation (NOF) . Physician's Guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation; 2003;
  26. US Preventive Services Task Force . Screening for osteoporosis in postmenopausal women. Washington DC: Office of Disease Prevention and Health Promotion; 2003;
  27. US Preventive Services Task Force . Screening for osteoporosis in postmenopausal women: recommendations and rationale. Annals of Internal Medicine. 2002;137:526–528
  28. Lewiecki EM, Watts NB, McClung MR, et al., For the International Society for Clinical Densitometry  Official position of the International Society for Clinical Densitometry. J Clin Endocrinol Metab. 2004;89:3651–3655
  29. Cheung AM, Feig DS, Kapral M, et al. Prevention of osteoporosis and osteoporotic fractures in postmenopausal women: recommendation statement from The Canadian Task Force on Preventive Health Care. Can Med Assoc J. 2004;170:1–9
  30. Osteoporose: Tweede Herziene Richtlijn. website English summary published in Pols HA, Wittenberg J. CBO guideline "Osteoporosis" (second version). NTVG Ned Tijdschr Geneeskd2002 www.cbo.nl/product/richtlijnen/folder20021023121843/article20021118165847/pdf/osteoporose2002;;146:1359–63
  31. Kanis JA, Delmas P, Burckhardt P, Cooper C, et al., on behalf of the European Foundation for Osteoporosis and Bone Disease  Guidelines for diagnosis and management of osteoporosis. Osteoporos Int. 1997;7:390–406
  32. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 1929-1936;2002:359
  33. Royal College of Physicians . Glucocorticoid-induced osteoporosis. Guidelines on prevention and treatment. Bone and Tooth Society of Great Britain, National Osteoporosis Society and Royal College of Physicians. London UK: Royal College of Physicians; 2002;
  34. National Osteoporosis Foundation . Analysis of the effectiveness and cost of screening and treatment strategies for osteoporosis. A basis for development of practice guidelines. Osteoporos Int. 1998;8(suppl 4):1–88
  35. National Osteoporosis Foundation . Physicians guide to prevention and treatment of osteoporosis. Washington: Excerpta Medica; 1998;
  36. Kanis JA, Burlet N, Cooper C, et al., On behalf of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)  European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2008;19:399–428
  37. Kanis JA, Adams J, Borgström F, et al. The cost-effectiveness of alendronate in the management of osteoporosis. Bone. 2008;42:4–15
  38. World Health Organization . Assessment of osteoporosis at the primary health care level. Summary Report of a WHO Scientific Group. WHO Geneva: WHO; 2007;www.who.int/chp/topics/rheumatic/en/index.html
  39. Kanis JA, Oden A, Johnell O, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. 2007;18:1033–1046
  40. Kanis JA, McCloskey EV, Johansson H, et al. Case finding for the management of osteoporosis with FRAX® - Assessment and intervention thresholds for the UK. Osteoporos Int;19:1395–1408 Erratum in Osteoporos Int. 2009;20:499–502
  41. Siminoski K, Leslie WD, Frame H, et al. Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment. J Clin Densitom. 2007;10:120–123
  42. Fujiwara S, Nakamura T, Orimo H, et al. Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX™). Osteoporos Int. 2008;19:429–448
  43. Kurth AA, Pfeilschifter J. [Diagnosis and treatment of postmenopausal osteoporosis and osteoporosis in men. German Guidelines Update 2006], Orthopade. 2007;36:683–690German
  44. Dawson-Hughes B, Tosteson AN, Melton LJ, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19:449–458
  45. Siris E, Delmas PD. Assessment of 10-year absolute risk: a new paradigm with worldwide application. Osteoporos Int. 2008;19:383–384
  46. Kanis JA, Stevenson M, McCloskey EV, et al. Glucocorticoid-induced osteoporosis: a systematic review and cost-utility. analysis. Health Technol Assess. 2007;11:1–256
  47. Kanis JA, Johnell O, on behalf of the Committee of Scientific Advisors of the International Osteoporosis Foundation . Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int. 2005;16:229–238
  48. Johansson H, Oden A, Johnell O, et al. Optimisation of BMD measurements to identify high risk groups for treatment – A test analysis. J Bone Miner Res. 2004;19:906–913
  49. Compston J, Cooper A, Cooper C, et al., On behalf of the National Osteoporosis Guideline Group (NOGG)  Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas. Maturitas; 2009;62:105–108
  50. National Osteoporosis Guideline Group on behalf of the Bone Research Society . British Geriatrics Society, British Society of Rheumatology, Society of Endocrinology, British Orthopaedic Association, Primary Care Rheumatology Society, Osteoporosis 2000 and Osteoporosis Dorset. Osteoporosis: Clinical guideline for prevention and treatment. Sheffield: UK. University of Sheffield Press; 2008;
  51. Orimo H, Sugioka Y, Fukunaga M, et al. Diagnostic criteria of primary osteoporosis. J Bone Miner Metab. 1998;16:139–150
  52. Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporosis Int. 1998;8:468–489
  53. Czerwiński E, Badurski JE, Marcinowska-Suchowierska E, Osieleniec J. Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Ortop Traumatol Rehabil. 2007;9:337–356
  54. Tsang SWY, Kung AWC, Kanis JA, et al. Ten-year fracture probability in Hong Kong southern Chinese according to age and BMD femoral neck T-scores. Osteoporos Int. 2009 Mar 27.;[Epub ahead of print] PMID: 19326036
  55. Lippuner K, Johansson H, Kanis JA, Rizzoli R. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int. 2009;20:1131–1140
  56. Eichler HG, Kong SX, Gerth , et al. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge?. Value Health. 2004;7:518–528
  57. Kanis JA, Jonsson B. Economic evaluation of interventions for osteoporosis. Osteoporos Int. 2002;13:765–767
  58. Kanis JA, Brazier JE, Stevenson M, et al. Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess. 2002;6:1–146
  59. National Institute for Health and Clinical Excellence . Final appraisal determination. Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. London: NICE; 2008;
  60. National Institute for Health and Clinical Excellence . Final appraisal determination. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women. London: NICE; 2008;
  61. Kanis JA, Borgstrom F, Zethraeus N, et al. Intervention thresholds for osteoporosis in the UK. Bone. 2005;36:22–32
  62. Kanis JA, Johnell O, Oden A, et al. Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int. 2005;16:6–14
  63. Borgstrom F, Johnell O, Kanis JA, et al. At what hip fracture risk is it cost-effective to treat? International Intervention thresholds for the treatment of osteoporosis. Osteoporos Int. 2006;17:1459–1471
  64. Tosteson AN, Melton LJ, Dawson-Hughes B, et al. National Osteoporosis Foundation Guide Committee. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19:437–447
  65. National Osteoporosis Foundation (NOF) . Clinician's Guide to prevention and treatment of osteoporosis. Washington: DC National Osteoporosis Foundation; 2008;
  66. Kanis JA, Black D, Cooper C, et al. A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int. 2002;13:527–536
  67. Committee for Medicinal Products for Human Use (CHMP) . Guideline on the evaluation of medicinal products in the treatment of primary osteoporosis. Ref CPMP/EWP/552/95Rev.2. London: CHMP; Nov 2006;
  68. Cranney A, Wells G, Willan A, et al. Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev. 2002;23:508–516
  69. Tosteson AN, Jonsson B, Grima DT, et al. Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions. Osteoporos Int. 2001;12:849–857
  70. Kanis JA, Johnell O, Oden A, et al. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19:385–397
  71. Borgström F, Strom O, Coelho J et al. The cost-effectiveness of risedronate in the UK for the management of osteoporosis. 2008 Submited, Feb 09.

PII: S1521-6942(09)00095-3

doi: 10.1016/j.berh.2009.09.002

Best Practice & Research Clinical Rheumatology
Volume 23, Issue 6 , Pages 711-726 , December 2009