National guidelines for diagnosis and treatment of osteoporosis in Slovakia

Osteoporosis is a chronic, systemic skeletal disease characterized by decreased bone mass and microarchitectural deterioration, leading to increased fracture risk. In Slovakia, its prevalence is estimated at 6%, with substantial health, social, and economic burdens.

The Slovak national guideline provides an overview for the diagnosis, prevention, and treatment of osteoporosis in Slovakia, reflecting recent scientific advances and recommendations from international bodies.

The guidelines were developed by a multidisciplinary expert panel and officially adopted by the Ministry of Health of the Slovak Republic. They are based on current evidence and international standards, including FRAX, IOF, ISCD, and ESCEO recommendations.

Diagnosis involves clinical risk assessment, biochemical testing, and imaging-primarily DXA and trabecular bone score. FRAX with or without BMD enhances risk stratification. Osteoporosis is categorized as primary or secondary. Prevention strategies include lifestyle modification, calcium and vitamin D supplementation, and fall risk reduction. Pharmacologic treatment includes antiresorptive agents (bisphosphonates, denosumab, SERMs), osteoanabolic (teriparatide, romosozumab), and hormone therapy when indicated. Sequential treatment strategies are emphasized, particularly in high-risk individuals. Treatment monitoring includes bone turnover markers and periodic DXA.  CONCLUSIONS: The Slovak guidelines provide a comprehensive and pragmatic approach for the management of osteoporosis across all stages, emphasizing early diagnosis, personalized treatment, and long-term fracture prevention. They align with European and global best practices and support clinical decision-making across specialties.