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Treatment reclassification in Canada from the Osteoporosis Canada 2023 clinical practice guidelines: the Manitoba BMD
William D Leslie1, Lisa M Lix2, Neil Binkley3
1Max Rady College of Medicine, University of Manitoba, C5121-409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada. bleslie@sbgh.mb.ca.
Abstract:
Osteoporosis Canada 2023 clinical practice guidelines increase the number of individuals recommended or suggested for anti-osteoporosis pharmacotherapy by refining treatment guidance for those who fell within the 2010 guidelines' moderate-risk category.
Purpose:
In 2023, Osteoporosis Canada updated its 2010 clinical practice guidelines based upon consideration of fracture history, 10-year major osteoporotic fracture (MOF) risk, and BMD T-score in conjunction with age. The 2023 guidelines eliminated risk categories, including the moderate-risk group that did not provide clear treatment guidance. The current study was performed to appreciate the implications of the shift from 2010 risk categories to 2023 treatment guidance.
Methods:
The study population consisted of 79,654 individuals age ≥ 50 years undergoing baseline DXA testing from January 1996 to March 2018. Each individual was assigned to mutually exclusive categories based on 2010 and 2023 guideline recommendations. Treatment qualification, 10-year predicted and 10-year observed MOF risk were compared.
Results:
Treatment reclassification under the 2023 guidelines only affected 33.8% of individuals in the 2010 moderate-risk group, with 13.0% assigned to no treatment, 14.4% to suggest treatment, and 6.4% to recommend treatment. During the mean follow-up of 7.2 years, 6364 (8.0%) individuals experienced one or more incidents of MOF. The observed 10-year cumulative incidence of MOF in the study population was 10.5% versus the predicted 10.7% (observed to predicted mean calibration ratio 0.98, 95% CI 0.96-1.00). Individuals reclassified from 2010 moderate risk to 2023 recommend treatment were at greater MOF risk than those in the 2010 moderate-risk group assigned to 2023 suggest treatment or no treatment, but at lower risk than those in the 2010 high-risk group.
Conclusions:
Osteoporosis Canada 2023 clinical practice guidelines affect individuals within the 2010 moderate-risk category, increasing the number for whom anti-osteoporosis pharmacotherapy is recommended or suggested. Increased treatment could reduce the population burden of osteoporotic fractures, though moderate-risk individuals now qualifying for treatment have a lower predicted and observed fracture risk than high-risk individuals recommended for treatment under the 2010 guidelines.
Insights
The 2023 Osteoporosis Canada guidelines refine treatment recommendations for osteoporosis, impacting individuals previously in the moderate-risk category. This update aims to increase appropriate anti-osteoporosis pharmacotherapy use and potentially reduce fracture burden.
Area of Science:
- Bone health and osteoporosis management.
- Clinical practice guideline evolution.
- Pharmacotherapy for fracture prevention.
Background:
- Osteoporosis Canada's 2010 guidelines provided risk categories for osteoporosis treatment.
- The 2010 guidelines' moderate-risk category lacked clear treatment direction.
- Updates in 2023 considered fracture history, 10-year major osteoporotic fracture (MOF) risk, and BMD T-score with age.
Purpose of the Study:
- To evaluate the impact of the 2023 Osteoporosis Canada guidelines on treatment recommendations.
- To compare patient classification under the 2010 and 2023 guidelines.
- To assess implications of shifting from risk categories to refined treatment guidance.
Main Methods:
- Analysis of 79,654 individuals aged ≥50 years with baseline DXA data (1996-2018).
- Categorization of individuals based on both 2010 and 2023 guideline recommendations.
- Comparison of treatment qualification, predicted 10-year MOF risk, and observed MOF risk.
Main Results:
- The 2023 guidelines reclassified 33.8% of the 2010 moderate-risk group: 13.0% to no treatment, 14.4% to suggest treatment, and 6.4% to recommend treatment.
- Over a mean follow-up of 7.2 years, 8.0% experienced MOF.
- Observed 10-year MOF incidence (10.5%) closely matched predicted risk (10.7%).
Conclusions:
- The 2023 Osteoporosis Canada guidelines increase the number of individuals recommended or suggested for anti-osteoporosis pharmacotherapy, particularly within the former moderate-risk group.
- This shift could lead to reduced population-level osteoporotic fractures.
- Individuals newly qualifying for treatment under the 2023 guidelines have lower fracture risk than those recommended for treatment under the 2010 high-risk category.
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