#NOGG2017

Updated 2017

Welcome to the NOGG 2017 Guideline Update. These new thresholds ensure equality of access to treatment for older patients with and without fracture (for full details, see the Guideline document)

Assessment threshold - Major fracture

10 year probability of major osteoporotic fracture (%)
Treat
Measure BMD
Lifestyle advice and reassure
If treatment is indicated, please click on the Treat item above to view guidance on related treatment options.
Prednisolone daily dose (or equivalent)
≥7.5mg daily
2.5-7.5mg daily

Interpretation

Following the assessment of fracture risk using FRAX® in the absence of BMD, the patient may be classified to be at low, intermediate or high risk.

  • Low risk reassure, give lifestyle advice, and reassess in 5 years or less depending on the clinical context.
  • Intermediate risk - measure BMD and recalculate the fracture risk to determine whether an individual's risk lies above or below the intervention threshold.
  • High risk - can be considered for treatment without the need for BMD, although BMD measurement may sometimes be appropriate, particularly in younger postmenopausal women.

NB - These thresholds are for guidance only and the final decision to assess BMD or to initiate therapeutic intervention lies with the individual clinician.

Management

  • For a more detailed description of investigations, supportive measures and treatments, please refer to the full Guideline.
  • No trials have been designed and powered to detect differences in the magnitude of fracture reduction between different treatments. Thus the choice of agent is determined by the spectrum of anti-fracture effects across skeletal sites, side effects and cost.
  • Treatment review should be performed after 3 years of zoledronic acid therapy and 5 years of oral bisphosphonate treatment.
  • Continuation of bisphosphonate treatment beyond 3-5 years can generally be recommended in individuals age >75 years, those with a history of hip or vertebral fracture, those who sustain a fracture while on treatment, and those taking oral glucocorticoids.
  • If treatment is discontinued, fracture risk should be reassessed after a new fracture, regardless of when this occurs. If no new fracture occurs, assessment of fracture risk should be performed again after 18 months to 3 years.
  • There is no evidence to guide decisions beyond 10 years of treatment and management options in such patients should be considered on an individual basis.

Centre for Metabolic Bone Diseases, University of Sheffield, UK