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Section 1: Scope of this guideline
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
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.
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
, 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.
The guideline has been prepared by a writing group (
Appendix 1) and has been approved after
consultation with stakeholders (Appendix
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.
The guideline is supported by a series of Frequently Asked Questions (FAQs)
available on the NOGG website.
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
4). The recommendations in this guideline were agreed by the National Osteoporosis Guideline Development
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.
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
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.