Do Different Countries Have Different Testing And Treatment

country protocols for osteoporosis

Researchers across the world are continually trying to find new and better ways to treat diseases. Whether it is bone diseases like osteoporosis or brain diseases like Alzheimer’s; the testing and treatment protocol for these diseases may change over time depending on the findings of research studies.

Testing and treatment protocols may also change depending on the recommendations and guidelines of the WHO (World Health Organization), the CDC (Centers For Disease Control And Prevention), and other concerned healthcare authorities in the country.

Here is a brief discussion about country protocols for osteoporosis whether the testing and treatment protocol is different for different countries and the standard protocols that most countries follow based on the guidelines of the WHO and CDC.

The testing protocol for osteoporosis

Most countries follow the standard protocol recommended by the WHO for the diagnosis of osteoporosis. There are no major differences in the protocol followed by most countries.

The basic guidelines involve measuring bone mineral density through imaging tests. Regular assessment of the patient’s bone density with the help of machines that use a low level of X-rays can determine the proportions of minerals like calcium in the bones. [1]

The test for bone mineral density is painless. The patient has to lie on a table while a scanner passes over his or her body. It is advisable to scan only a few bones like the hip and the spine to assess bone mineral density. 

These bones are the most commonly affected due to the impact of aging and hormonal changes. They are more likely to have fractures because of their continuous movement and the weight exerted on them. Hence, healthcare authorities of most countries recommend scanning the hip bone and spine for the diagnosis of osteoporosis. [2]

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According to a CDC publication, “Screening for osteoporosis with the help of FRAX Risk Assessment tool is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, which include having a parent who has broken a hip. It uses several factors to determine how likely you are to have osteoporosis.

Screening for osteoporosis is commonly done using a type of low-level x-rays called dual/energy x-ray absorptiometry (DXA). Screening also can show if you have low bone mass, meaning your bones are weaker than normal and are likely to develop osteoporosis.” [3]

Treatment protocol for osteoporosis 

Treatment recommendations for osteoporosis are usually based on the estimate of the patient’s risk of fractures in the next 10 years based on information like the bone density test. Patients may be treated with some of the following medications: 

Bisphosphonates

For men and women at an increased risk of fractures, recommended treatment protocols include medications like bisphosphonates. [4]

Intravenous forms of bisphosphonates are recommended for patients who suffer from hyperacidity, heartburn, and indigestion. Intravenous bisphosphonates do not cause stomach upsets. Additionally, it may be easier for patients to schedule yearly or quarterly injections than to take monthly or weekly pills. [5]

Monoclonal antibody medications

The treatment protocols in most countries includes the use of monoclonal antibody medications such as denosumab that may produce similar or better results for improving bone density compared to bisphosphonates. 

Denosumab can be delivered as an injection under the skin once every six months. Denosumab can strengthen the bones and reduce the risk of fractures[6]

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Hormone-related therapy

Estrogen plays a major role in bone health in younger women. Women who suffer from severe menopausal symptoms may also be advised to use estrogen-based medications.

In men, osteoporosis may be associated with a gradual decline in testosterone production. Testosterone replacement therapy could help to improve the symptoms of osteoporosis.

Bone-building medications

Healthcare authorities recommend the use of several bone-building medications based on individual symptoms and the risk profile of the patients. [7]

Some of the commonly used bone-building medications in most countries include: 

  • Teriparatide
  • Abaloparatide 
  • Romosozumab 

Recommendations for treatment country protocols for osteoporosis by ACP

There may be slight variations in the diagnosis and treatment criteria in different countries based on the findings of research studies. 

For example; the American College of Physicians (ACP) has issued specific guidelines for treating the loss of bone density in patients above 50 years of age. 

According to the ACP, it is estimated that nearly 54 million adult men and women in the United States suffer from low bone mineral density or osteoporosis. Also, nearly 50% of Americans above the age of 50 are at risk of developing an osteoporotic fracture.

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In this publication, the ACP president, Jack Ende, has stated that “Physicians should prescribe generic drugs to treat patients with osteoporosis whenever possible and they should discuss the importance of medication adherence, especially for bisphosphonates.” [8]

The ACP has recommended treating women using medications like bisphosphonates (risedronate, alendronate, or zoledronic acid) or a biologic agent like denosumab. The guidelines also include the use of estrogen-based drugs, when appropriate.

These guidelines by the ACP for the management of osteoporosis are focused on the comparative short-term and long-term advantages as well as disadvantages of using medications and supplements like calcium and vitamin D. 

It also suggests that women with osteoporosis should be treated with drug therapy for 5 years. Continuing the treatment after the initial 5 years could be beneficial in some women and maybe recommended only after re-assessing the possible risks and benefits involved in continuing the therapies. 

Also, while most healthcare authorities recommend regular testing with bone scans, and X-rays to assess the response of the patient to the treatment; ACP advises otherwise. [9]

According to the ACP, bone density monitoring should be avoided during the 5-year treatment phase as there is no evidence showing any benefits from regular monitoring during therapy. 

The ACP also advises against including estrogen therapy and estrogen plus progestin therapy for the management of osteoporosis in all menopausal women. [10]

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Conclusion

Different countries may have different protocols for the diagnosis and treatment of osteoporosis.

However, the aim of each protocol is to detect the condition before a severe decline in bone mineral density occurs resulting in a fracture. The treatments are, in general, aimed at improving bone density to make the bones stronger and resistant to fractures.

References:

  1. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/osteoporosis-screening
  2. http://www.shef.ac.uk/FRAX/
  3. https://www.cdc.gov/genomics/disease/osteoporosis.htm
  4. https://www.womenshealth.gov/a-z-topics/osteoporosis
  5. https://www.versusarthritis.org/about-arthritis/treatments/drugs/bisphosphonates/
  6. https://www.ajmc.com/view/fda-approves-new-treatment-for-postmenopausal-women-with-osteoporosis
  7. https://www.mayoclinic.org/diseases-conditions/osteoporosis/diagnosis-treatment/drc-20351974
  8. http://annals.org/aim/article/doi/10.7326/M15-1361
  9. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening
  10. https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-low-bone-density-or-osteoporosis-to

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