Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region
SUMMARY: Guidelines for doctors managing osteoporosis in the Asia-Pacific region vary widely. We compared 18 guidelines for similarities and differences in five key areas. We then used a structured consensus process to develop clinical standards of care for the diagnosis and management of osteoporos...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer London
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192320/ https://www.ncbi.nlm.nih.gov/pubmed/33502559 http://dx.doi.org/10.1007/s00198-020-05742-0 |
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author | Chandran, M. Mitchell, P. J. Amphansap, T. Bhadada, S. K. Chadha, M. Chan, D.-C. Chung, Y.-S. Ebeling, P. Gilchrist, N. Habib Khan, A. Halbout, P. Hew, F. L. Lan, H.-P. T. Lau, T. C. Lee, J. K. Lekamwasam, S. Lyubomirsky, G. Mercado-Asis, L. B. Mithal, A. Nguyen, T. V. Pandey, D. Reid, I. R. Suzuki, A. Chit, T. T. Tiu, K. L. Valleenukul, T. Yung, C. K. Zhao, Y. L. |
author_facet | Chandran, M. Mitchell, P. J. Amphansap, T. Bhadada, S. K. Chadha, M. Chan, D.-C. Chung, Y.-S. Ebeling, P. Gilchrist, N. Habib Khan, A. Halbout, P. Hew, F. L. Lan, H.-P. T. Lau, T. C. Lee, J. K. Lekamwasam, S. Lyubomirsky, G. Mercado-Asis, L. B. Mithal, A. Nguyen, T. V. Pandey, D. Reid, I. R. Suzuki, A. Chit, T. T. Tiu, K. L. Valleenukul, T. Yung, C. K. Zhao, Y. L. |
author_sort | Chandran, M. |
collection | PubMed |
description | SUMMARY: Guidelines for doctors managing osteoporosis in the Asia-Pacific region vary widely. We compared 18 guidelines for similarities and differences in five key areas. We then used a structured consensus process to develop clinical standards of care for the diagnosis and management of osteoporosis and for improving the quality of care. PURPOSE: Minimum clinical standards for assessment and management of osteoporosis are needed in the Asia-Pacific (AP) region to inform clinical practice guidelines (CPGs) and to improve osteoporosis care. We present the framework of these clinical standards and describe its development. METHODS: We conducted a structured comparative analysis of existing CPGs in the AP region using a “5IQ” model (identification, investigation, information, intervention, integration, and quality). One-hundred data elements were extracted from each guideline. We then employed a four-round Delphi consensus process to structure the framework, identify key components of guidance, and develop clinical care standards. RESULTS: Eighteen guidelines were included. The 5IQ analysis demonstrated marked heterogeneity, notably in guidance on risk factors, the use of biochemical markers, self-care information for patients, indications for osteoporosis treatment, use of fracture risk assessment tools, and protocols for monitoring treatment. There was minimal guidance on long-term management plans or on strategies and systems for clinical quality improvement. Twenty-nine APCO members participated in the Delphi process, resulting in consensus on 16 clinical standards, with levels of attainment defined for those on identification and investigation of fragility fractures, vertebral fracture assessment, and inclusion of quality metrics in guidelines. CONCLUSION: The 5IQ analysis confirmed previous anecdotal observations of marked heterogeneity of osteoporosis clinical guidelines in the AP region. The Framework provides practical, clear, and feasible recommendations for osteoporosis care and can be adapted for use in other such vastly diverse regions. Implementation of the standards is expected to significantly lessen the global burden of osteoporosis. |
format | Online Article Text |
id | pubmed-8192320 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer London |
record_format | MEDLINE/PubMed |
spelling | pubmed-81923202021-06-28 Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region Chandran, M. Mitchell, P. J. Amphansap, T. Bhadada, S. K. Chadha, M. Chan, D.-C. Chung, Y.-S. Ebeling, P. Gilchrist, N. Habib Khan, A. Halbout, P. Hew, F. L. Lan, H.-P. T. Lau, T. C. Lee, J. K. Lekamwasam, S. Lyubomirsky, G. Mercado-Asis, L. B. Mithal, A. Nguyen, T. V. Pandey, D. Reid, I. R. Suzuki, A. Chit, T. T. Tiu, K. L. Valleenukul, T. Yung, C. K. Zhao, Y. L. Osteoporos Int Consensus Statement SUMMARY: Guidelines for doctors managing osteoporosis in the Asia-Pacific region vary widely. We compared 18 guidelines for similarities and differences in five key areas. We then used a structured consensus process to develop clinical standards of care for the diagnosis and management of osteoporosis and for improving the quality of care. PURPOSE: Minimum clinical standards for assessment and management of osteoporosis are needed in the Asia-Pacific (AP) region to inform clinical practice guidelines (CPGs) and to improve osteoporosis care. We present the framework of these clinical standards and describe its development. METHODS: We conducted a structured comparative analysis of existing CPGs in the AP region using a “5IQ” model (identification, investigation, information, intervention, integration, and quality). One-hundred data elements were extracted from each guideline. We then employed a four-round Delphi consensus process to structure the framework, identify key components of guidance, and develop clinical care standards. RESULTS: Eighteen guidelines were included. The 5IQ analysis demonstrated marked heterogeneity, notably in guidance on risk factors, the use of biochemical markers, self-care information for patients, indications for osteoporosis treatment, use of fracture risk assessment tools, and protocols for monitoring treatment. There was minimal guidance on long-term management plans or on strategies and systems for clinical quality improvement. Twenty-nine APCO members participated in the Delphi process, resulting in consensus on 16 clinical standards, with levels of attainment defined for those on identification and investigation of fragility fractures, vertebral fracture assessment, and inclusion of quality metrics in guidelines. CONCLUSION: The 5IQ analysis confirmed previous anecdotal observations of marked heterogeneity of osteoporosis clinical guidelines in the AP region. The Framework provides practical, clear, and feasible recommendations for osteoporosis care and can be adapted for use in other such vastly diverse regions. Implementation of the standards is expected to significantly lessen the global burden of osteoporosis. Springer London 2021-01-27 2021 /pmc/articles/PMC8192320/ /pubmed/33502559 http://dx.doi.org/10.1007/s00198-020-05742-0 Text en © The Author(s) 2021, corrected publication 2021 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Consensus Statement Chandran, M. Mitchell, P. J. Amphansap, T. Bhadada, S. K. Chadha, M. Chan, D.-C. Chung, Y.-S. Ebeling, P. Gilchrist, N. Habib Khan, A. Halbout, P. Hew, F. L. Lan, H.-P. T. Lau, T. C. Lee, J. K. Lekamwasam, S. Lyubomirsky, G. Mercado-Asis, L. B. Mithal, A. Nguyen, T. V. Pandey, D. Reid, I. R. Suzuki, A. Chit, T. T. Tiu, K. L. Valleenukul, T. Yung, C. K. Zhao, Y. L. Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region |
title | Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region |
title_full | Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region |
title_fullStr | Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region |
title_full_unstemmed | Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region |
title_short | Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region |
title_sort | development of the asia pacific consortium on osteoporosis (apco) framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the asia-pacific region |
topic | Consensus Statement |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192320/ https://www.ncbi.nlm.nih.gov/pubmed/33502559 http://dx.doi.org/10.1007/s00198-020-05742-0 |
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