Update of the Dutch multidisciplinary guideline on osteoporosis and fracture prevention

Update of the Dutch multidisciplinary guideline on osteoporosis and fracture prevention

A multidisciplinary working group was formed in Netherlands, in order to update the Dutch multidisciplinary guideline on osteoporosis and fracture prevention and facilitate its implementation.  Five novel recommendations were included, that are a crucial step forward in the optimization of diagnosis and treatment for fracture prevention. 

What is new in the Dutch Multidisciplinary Guideline Osteoporosis and Fracture Prevention?

  • Diagnosis: In all patients with an indication for DXA of lumbar spine and hip, lateral imaging of the spine has to be performed with vertebral fracture assessment (VFA)
  • Treatment: Directly starting with anabolic drugs (teriparatide or romosozumab) in patients with a very high fracture risk
  • Treatment: Directly starting with second-line drugs (denosumab, teriparatide, zoledronic acid) in glucocorticoid-induced osteoporosis at very high fracture risk
  • Treatment: Directly starting with zoledronic acid in patients 75 years and over with a hip fracture (independent of DXA)
  • Management: A lifelong fracture prevention strategy is indicated from the start of the first treatment

Moreover, 5 flowcharts were developed, which may be helpful for physicians and their patients in daily practice:

  1. Treatment advice for patients treated with glucocorticoids
  2. Evaluation of therapy-naive patient≥50 years with a recent fracture
  3. Evaluation of therapy-naive patient without a fracture but with increased risk profile
  4. Evaluation on therapy: bisphosphonates
  5. Evaluation on therapy: denosumab

According to the authors: ‘It is useful to bring country-specific recommendations and guidelines in the international arena; it may improve communication between countries, and we can learn from each other.

Read the article here!

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