Section 1: Scope of this guideline

  1. This updated guideline has been prepared with the support of the societies listed to provide guidance on prevention and treatment of osteoporosis with the overarching aim of reducing fragility fracture risk. This guideline updates previous National Osteoporosis Guideline Group (NOGG) guidance 1-3.
  2. The scope of the guideline is to review the assessment and diagnosis of osteoporosis, the therapeutic interventions available and the approaches for the prevention of fragility fractures, in postmenopausal women, and in men aged 50 years or older. This focus is chosen as fragility fractures and osteoporosis are uncommon in premenopausal women, and men younger than 50 years and therefore when these occur patients need thorough investigation for secondary causes of osteoporosis, and careful consideration of treatment options. Specialist referral is usually required.
  3. This NOGG guidance has appraised the current evidence-base to inform these updated recommendations. The aim of the guideline is to provide clinically appropriate recommendations which integrate available evidence on clinical efficacy, effectiveness and safety. This contrasts with, but complements, the remit of the National Institute for Health and Care Excellence (NICE) , which focuses principally on establishing criteria for cost effectiveness. Cost effectiveness analyses are generally supportive for treatment guided by clinical effectiveness thresholds, rather than defining intervention thresholds per se 4. The NOGG recommendations have been previously demonstrated to be cost-effective and at the time of writing, NICE’s appraisal of romosozumab is awaited, with preliminary evidence of its cost-effectiveness established 5.
  4. The guideline has been prepared by a writing group ( Appendix 1) and has been approved after consultation with stakeholders (Appendix 2).
  5. The guideline is intended for all healthcare professionals involved in the prevention and treatment of osteoporosis and fragility fractures. This includes primary care practitioners, allied health professionals and relevant specialists in secondary care including rheumatologists, gerontologists, gynaecologists, endocrinologists, clinical biochemists, and orthopaedic surgeons. The guideline includes recommendations for training in osteoporosis care.
  6. The guideline is supported by a series of Frequently Asked Questions (FAQs) available on the NOGG website.
  7. The conclusions and recommendations in the document are systematically graded, according to the quality of information available, to indicate the level of evidence on which recommendations are based. The grading methodology is summarised in Appendix 3. Where available, systematic reviews, meta-analyses and randomized controlled trials have been used to provide the evidence base. The evidence base has been updated using PubMed to identify systematic reviews and meta- analyses from July 2016 to Sept 2020. The quality of systematic reviews and meta-analyses used in the formulation of recommendations was assessed using AMSTAR2 (Appendix 4). The recommendations in this guideline were agreed by the National Osteoporosis Guideline Development Group.
  8. It is recommended that the guideline is reviewed at an interval of not more than 5 years. Earlier revision may be necessary if new drugs are approved or there is a major change to the evidence base. Minor changes, for example extension of an indication, new safety data or changes to the Summary of Product Characteristics (SPC) of an intervention, will be made on the website when and if appropriate.
  9. This guideline provides a framework from which local management protocols should be developed to provide advice for healthcare professionals. Implementation of this guideline should be audited at a local and national level.
  10. The recommendations in the guideline should be used to aid management decisions but do not replace the need for clinical judgment in the care of individual patients in clinical practice.