Clinical guidelines for the diagnosis and treatment of osteoporosis.

ging of the population is expected to increase the frequency, cost, and burden of fractures associated with agerelated bone loss. Guidelines on prevention, screening, diagnosis, and treatment of osteoporosis are available from several organizations. In July, 2013, the Institute for Clinical Systems Improvement (ICSI) released an update to its Health Care Guideline for the Diagnosis and Treatment of Osteoporosis (Available at: https://ww.icsi.org/guidelines_ more/). This is the eighth edition of the evidence-based guideline. For the first time, ICSI used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. The guideline group considered systematic reviews and randomized controlled trials published between January, 2010 and January, 2013, that evaluated frequency of dual-energy X-ray absorptiometry (DXA), primary and secondary workups, fracture risk assessment (FRAX), calcium as it pertains to cardiovascular risk, osteoporosis in men, vitamin D, and denosumab. The guideline focuses on adults only and discusses prevention, diagnosis and treatment. To achieve these aims, the guideline provides two recommendations: ❚ Clinicians should discuss risk factors for osteoporosis and primary prevention with all patients presenting for preventive/wellness health visits. ❚ Address options for prevention and treatment of osteoporosis, including pharmacologic intervention if appropriate, and engage the patient in shared decision-making to facilitate discussions on treatment options.