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Practice Guideline
. 2017 Nov;18(Suppl 1):3-36.
doi: 10.1007/s10195-017-0474-7.

Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology

Umberto Tarantino  1 , Giovanni Iolascon  2 , Luisella Cianferotti  3 , Laura Masi  3 , Gemma Marcucci  3 , Francesca Giusti  3 , Francesca Marini  3 , Simone Parri  3 , Maurizio Feola  1 , Cecilia Rao  1 , Eleonora Piccirilli  1 , Emanuela Basilici Zanetti  4 , Noemi Cittadini  4 , Rosaria Alvaro  4 , Antimo Moretti  2 , Dario Calafiore  2 , Giuseppe Toro  2 , Francesca Gimigliano  2 , Giuseppina Resmini  5 , Maria Luisa Brandi  6
Affiliations
Practice Guideline

Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology

Umberto Tarantino et al. J Orthop Traumatol. 2017 Nov.

Abstract

Background: The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences.

Materials and methods: Literature reviews by a multidisciplinary team.

Results: The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1-3). Toolboxes for everyday clinical practice are provided.

Conclusions: The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.

Keywords: Bisphosphonates; Denosumab; Fracture; Fracture liaison service; Guidance; Strontium ranelate; Teriparatide.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest to disclose relevant to the subject of this article.

Ethics approval and consent to participate

Not applicable.

Funding

Publication of this article was funded by the Società Italiana di Ortopedia e Traumatologia (SIOT).

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Figures

Fig. 1
Fig. 1
Toolbox for guidance: definition of osteoporosis
Fig. 2
Fig. 2
Toolbox for guidance: diagnosis of osteoporosis
Fig. 3
Fig. 3
Toolbox for guidance: osteoporotic fracture risk assessment
Fig. 4
Fig. 4
Toolbox for guidance: general strategies for prevention and treatment
Fig. 5
Fig. 5
a Assessment of fracture risk in postmenopausal women when DEXA is widely available. b Assessment of fracture risk in postmenopausal women when access to DEXA is limited (reproduced from [2])
Fig. 6
Fig. 6
Toolbox for guidance: pharmacologic treatment
Fig. 7
Fig. 7
Model of a fracture liaison service (FLS)
Fig. 8
Fig. 8
Toolbox for guidance: integrated approaches
See this image and copyright information in PMC

References

    1. Italian Society of Orthopaedics and Traumatology. Orthopaedic surgery in Italy. http://www.siot.it/pagine/about/. Accessed July 17th 2017
    1. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY, Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24:23–57. - PMC - PubMed
    1. International Osteoporosis Foundation. Europe guidelines. https://www.iofbonehealth.org/europe-guidelines. Accessed 22 June 2016
    1. Consensus Development Conference Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94:646–650. - PubMed
    1. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ, 3rd, Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42:467–475. - PubMed

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