{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:12:05Z","timestamp":1767093125302},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2018,1,5]],"date-time":"2018-01-05T00:00:00Z","timestamp":1515110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The development of clinical guidelines is now a more uniform process, with formalised methods to ensure that recommendations are based on current best available evidence from randomised controlled trials and systematic reviews. Over the past 20 years we have seen a growth in guidelines including those relating to osteoporosis, with recommendations varying between and within countries. Some guidelines are concerned with case finding and primary or secondary prevention, such as those produced by the National Institute for Health and Care Excellence (NICE CG146, TA-160, -161, -464), while others focus on specific conditions or risk factors associated with osteoporosis, such as the menopause, coeliac disease and eating disorder. Clinicians can be confused as to which to follow in any particular clinical scenario. International guidelines, such as those from North America (NOF, CAROC, AACE) and Scotland (SIGN 142), differ from those of England, Wales and Northern Ireland, with recent recommendations from NICE (TA464) shifting the focus of treatment from those at greatest fracture risk to an apparent blanket approach, based on cost-effectiveness, rather than clinical effectiveness.<\/jats:p><jats:p>Osteoporosis treatment should be targeted at those who can benefit most, outweighing the potential for harm. If the low health economic threshold of NICE TA464 were adopted as a clinical threshold, the most important group\u2014older people at greatest risk of fracture, would not be prioritised. We risk overwhelming clinical services, while causing harm to some at low fracture risk from adverse effects of treatment, yet failing to treat the older population at highest fracture risk.<\/jats:p>","DOI":"10.1093\/ageing\/afx197","type":"journal-article","created":{"date-parts":[[2017,12,18]],"date-time":"2017-12-18T20:20:39Z","timestamp":1513628439000},"page":"334-339","source":"Crossref","is-referenced-by-count":16,"title":["Implications of guidelines for osteoporosis and its treatment"],"prefix":"10.1093","volume":"47","author":[{"given":"Stephen","family":"Tuck","sequence":"first","affiliation":[{"name":"Institute for Cellular Medicine Newcastle University, Newcastle upon Tyne NE2 4HH, UK"},{"name":"Rheumatology Department, James Cook Hospital, Middlesbrough TS4 3BW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A","family":"Little","sequence":"additional","affiliation":[{"name":"The Bone Clinic Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK"},{"name":"Gosforth Memorial Medical Centre, Newcastle upon Tyne NE3 1TX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry J","family":"Aspray","sequence":"additional","affiliation":[{"name":"Institute for Cellular Medicine Newcastle University, Newcastle upon Tyne NE2 4HH, UK"},{"name":"The Bone Clinic Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK"},{"name":"NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,1,5]]},"reference":[{"key":"2023022012280114100_","volume-title":"WHO Guidelines Approved by the Guidelines Review Committee","author":"Guidelines Review Committee","year":"2017"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1001\/jama.287.5.612","article-title":"Relationships between authors of clinical practice guidelines and the pharmaceutical industry","volume":"287","author":"Choudhry","year":"2002","journal-title":"J Am Med Assoc"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1136\/bmj.318.7183.593","article-title":"Clinical guidelines: developing guidelines","volume":"318","author":"Shekelle","year":"1999","journal-title":"Br Med J"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"e016948","DOI":"10.1136\/bmjopen-2017-016948","article-title":"Reaching consensus on reporting patient and public involvement (PPI) in research: methods and lessons learned from the development of reporting guidelines","volume":"7","author":"Brett","year":"2017","journal-title":"BMJ Open"},{"key":"2023022012280114100_","volume-title":"SIGN 50: A Guideline Developer\u2019s Handbook. Scottish Intercollegiate Guidelines Network","author":"Scottish Intercollegiate Guidelines Network","year":"2015"},{"key":"2023022012280114100_","volume-title":"Developing NICE Guidelines: The Manual [PMG20]","author":"National Institute for Health and Care Excellence","year":"2017"},{"key":"2023022012280114100_","article-title":"Patients denied osteoporosis drug","author":"Sample","year":"2009","journal-title":"The Guardian"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.maturitas.2017.08.002","article-title":"NOGG and NICE: new guidelines and quality standards for osteoporosis","volume":"106","author":"Compston","year":"2017","journal-title":"Maturitas"},{"key":"2023022012280114100_","author":"Scottish Intercollegiate Guidelines Network (SIGN)","year":"2015"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s00198-012-2074-y","article-title":"European guidance for the diagnosis and management of osteoporosis in postmenopausal women","volume":"24","author":"Kanis","year":"2013","journal-title":"Osteoporos Int"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1503\/cmaj.100771","article-title":"2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary","volume":"182","author":"Papaioannou","year":"2010","journal-title":"CMAJ"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1007\/s00198-014-2794-2","article-title":"Clinician\u2019s guide to prevention and treatment of osteoporosis","volume":"25","author":"Cosman","year":"2014","journal-title":"Osteoporos Int"},{"issue":"Suppl. 4","key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4158\/EP161435.GL","article-title":"American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis\u20142016","volume":"22","author":"Camacho","year":"2016","journal-title":"Endocr Pract"},{"key":"2023022012280114100_","author":"National Institute for Health and Care Excellence","year":"2017"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.maturitas.2017.01.010","article-title":"Vitamin D prescribing in older people in the UK depends on postcode","volume":"99","author":"Hill","year":"2017","journal-title":"Maturitas"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1016\/S0140-6736(17)32850-7","article-title":"Bisphosphonates in osteoporosis: NICE and easy?","volume":"390","author":"Harvey","year":"2017","journal-title":"Lancet"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1001\/jama.2011.190","article-title":"Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women","volume":"305","author":"Park-Wyllie","year":"2011","journal-title":"J Am Med Assoc"},{"key":"2023022012280114100_","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1359\/jbmr.0707onj","article-title":"Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research","volume":"22","author":"Khosla","year":"2007","journal-title":"J Bone Miner Res"},{"key":"2023022012280114100_","first-page":"OP12","article-title":"Fracture risk assessment in a primary care population: case finding using routine GP data, FRAX\u00ae And RAIDR\u00ae in the United Kingdom","volume":"1","author":"Aspray","year":"2013","journal-title":"Bone Abstr"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/47\/3\/334\/49273322\/ageing_47_3_334.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/47\/3\/334\/49273322\/ageing_47_3_334.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T01:18:35Z","timestamp":1693358315000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/47\/3\/334\/4791138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,5]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afx197","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,5]]},"published":{"date-parts":[[2018,1,5]]}}}