• Michigan Quality Improvement Consortium. Management and prevention of osteoporosis. Southfield (MI): Michigan Quality Improvement Consortium; 2008 Jan. 1 p.

This is the current release of the guideline.

This guideline updates a previous version: Management of osteoporosis. Southfield (MI): Michigan Quality Improvement Consortium; 2003 Oct. 1 p.

The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.

Assessment

• Assess for loss of height (>1.5 inches) and back pain
• Assess other risk factors:

  Modifiable:

  • Current cigarette smoking
  • Low body weight (<127 lbs or body mass index [BMI] <20)
  • Endocrine disorders
    • Premature or surgical menopause
    • Chronic corticosteroid therapy
    • Estrogen or testosterone deficiency
    • Excessive thyroid hormone replacement
  • Calcium or vitamin D deficiency
  • Excessive alcohol intake (more than two drinks per day)
  • Inadequate physical activity

  Non-Modifiable:

  • Family history of osteoporosis
  • Caucasian or Asian race
  • Advanced age (> age 65)
  • Female gender
  • History of atraumatic fracture
• Bone mineral density (BMD) testing using dual energy x-ray absorptiometry (DEXA) spine and total hip
• Computed tomography (CT) scan for screening is not recommended

Eligible Population

Patients at high risk for osteoporosis

Frequency

• Adult height assessments at periodic well exams
• BMD test for initial diagnosis [D]

Core Principles of Treatment and Prevention

Regardless of Risk Factors:

• Dietary calcium 1200 mg/d and 800 to 1000 international units (IU) vitamin D₃ [B]
• Weight-bearing exercise [A]
• Address modifiable risk factors above

Eligible Population

Patients at high risk for osteoporosis

Frequency

• BMD testing more often than every two years is generally not useful.
• Consider rechecking BMD after at least two years of pharmacologic treatment to monitor effectiveness [D].

Patient Selection for Pharmacological Management Based on Dual Energy X-Ray Absorptiometry

• Treatment to prevent fractures in osteopenia (T-score between -1 and -2.0) without risk factors is not useful [D]
• Treat patients on corticosteroid therapy with a T-score < -1.0 [A]
• Treat patients with osteopenia and a T-score between -2.0 and -2.5 at increased risk [D]
• Patients with osteoporosis [T-score < -2.5] (Osteopenia associated with atraumatic fracture should be treated as osteoporosis [D])

Eligible Population

Patients requiring therapy to reduce high risk of fracture

Pharmacological Management

• Consider oral bisphosphonate, generic if available¹
• Consider referral to endocrine or bone and mineral metabolism specialist if patient does not tolerate treatment or shows progression or recurrent fracture after 2 years on treatment

Eligible Population

• Patients requiring therapy to reduce high risk of fracture

¹Use caution in patients with active upper gastrointestinal (GI) disorders. Take medication on an empty stomach with water, remain upright, no food or beverage for 30 minutes, (60 minutes for ibandronate).

Definitions:

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

None provided

• Michigan Quality Improvement Consortium. Management and prevention of osteoporosis. Southfield (MI): Michigan Quality Improvement Consortium; 2008 Jan. 1 p.

2003 Oct (revised 2008 Jan)

Michigan Quality Improvement Consortium - Professional Association

Michigan Quality Improvement Consortium

Michigan Quality Improvement Consortium Medical Director's Committee

Physician representatives from participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health and Michigan Peer Review Organization

Standard disclosure is requested from all individuals participating in the Michigan Quality Improvement Consortium (MQIC) guideline development process, including those parties who are solicited for guideline feedback (e.g., health plans, medical specialty societies). Additionally, members of the MQIC Medical Directors' Committee are asked to disclose all commercial relationships.

This is the current release of the guideline.

This guideline updates a previous version: Management of osteoporosis. Southfield (MI): Michigan Quality Improvement Consortium; 2003 Oct. 1 p.

None available

None available

This NGC summary was completed by ECRI on April 14, 2004. The information was verified by the guideline developer on July 27, 2004. This NGC summary was updated by ECRI on October 13, 2006. The updated information was verified by the guideline developer on November 3, 2006. This summary was updated by ECRI Institute on April 14, 2008. The updated information was verified by the guideline developer on April 18, 2008.

This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.