Clinical guidelines for the management of osteoporosis in China: a systematic review

The rising prevalence of osteoporosis and related fractures contributes substantially to the clinical and economic burden in China, particularly in the context of an ageing population. In response, various Chinese medical specialties and organisations have developed clinical guidelines for osteoporosis management, specifically tailored to the needs of the Chinese population. This systematic review aimed to compare and evaluate the consistency and divergence among these guidelines.

A systematic search of Medline, Embase, Cochrane Library, and Web of Science was conducted for English-language papers. As well, a search of Chinese databases (China National Knowledge Infrastructure and Wanfang) and Chinese government websites was conducted. The search included documents published up to 13 August 2026. Article screening and data extraction were conducted by two independent reviewers. Management guidelines for primary osteoporosis in Chinese adults were included. Exclusion criteria were guidelines for secondary osteoporosis, guidelines for osteoporotic fractures that did not address osteoporosis management, previous versions of guidelines, and management protocols specific to local hospitals, organisations, communities, or rehabilitation centres. The methodological quality of guidelines was evaluated with the Appraisal of Guidelines for Research & Evaluation II (AGREE II).

Our search yielded 8,100 records, from which 32 guidelines produced by over 60 professional societies across multiple medical specialties were included. While there was consensus on the definition of osteoporosis, diagnostic criteria, prevention strategies, and the inclusion of both pharmacological and non-pharmacological treatment approaches, notable differences emerged in specific treatment recommendations. These discrepancies often reflected differences in the clinical focus of individual disciplines, such as orthopaedics, endocrinology, and geriatrics, particularly regarding diagnosis, treatment or rehabilitation, and patient populations. Unlike other international guidelines, fracture liaison services and health economic considerations, including cost-effectiveness analyses, were addressed in only some of the included guidelines.

This systematic review synthesises current osteoporosis management guidelines in China and highlights important inconsistencies in recommendations. The findings underscore the need for high-quality, context-specific research and greater incorporation of health economic evidence to inform the development of more coherent and evidence-based national guidelines.

https://osf.io/j83s4/, identifier j83s4.