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      Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

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          Abstract

          Summary

          The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures.

          Introduction

          The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture.

          Methods

          The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation’s Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized.

          Results and Conclusion

          The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.

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          Most cited references146

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          General cardiovascular risk profile for use in primary care: the Framingham Heart Study.

          Separate multivariable risk algorithms are commonly used to assess risk of specific atherosclerotic cardiovascular disease (CVD) events, ie, coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure. The present report presents a single multivariable risk function that predicts risk of developing all CVD and of its constituents. We used Cox proportional-hazards regression to evaluate the risk of developing a first CVD event in 8491 Framingham study participants (mean age, 49 years; 4522 women) who attended a routine examination between 30 and 74 years of age and were free of CVD. Sex-specific multivariable risk functions ("general CVD" algorithms) were derived that incorporated age, total and high-density lipoprotein cholesterol, systolic blood pressure, treatment for hypertension, smoking, and diabetes status. We assessed the performance of the general CVD algorithms for predicting individual CVD events (coronary heart disease, stroke, peripheral artery disease, or heart failure). Over 12 years of follow-up, 1174 participants (456 women) developed a first CVD event. All traditional risk factors evaluated predicted CVD risk (multivariable-adjusted P<0.0001). The general CVD algorithm demonstrated good discrimination (C statistic, 0.763 [men] and 0.793 [women]) and calibration. Simple adjustments to the general CVD risk algorithms allowed estimation of the risks of each CVD component. Two simple risk scores are presented, 1 based on all traditional risk factors and the other based on non-laboratory-based predictors. A sex-specific multivariable risk factor algorithm can be conveniently used to assess general CVD risk and risk of individual CVD events (coronary, cerebrovascular, and peripheral arterial disease and heart failure). The estimated absolute CVD event rates can be used to quantify risk and to guide preventive care.
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            Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

            The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.
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              Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

              Background It is increasingly acknowledged that ‘acceptability’ should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Methods Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. Results From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Conclusion Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2031-8) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                e.v.mccloskey@sheffield.ac.uk
                Journal
                Arch Osteoporos
                Arch Osteoporos
                Archives of Osteoporosis
                Springer London (London )
                1862-3522
                1862-3514
                28 June 2022
                28 June 2022
                2022
                : 17
                : 1
                : 87
                Affiliations
                [1 ]GRID grid.11835.3e, ISNI 0000 0004 1936 9262, Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, , University of Sheffield, ; Sheffield, UK
                [2 ]GRID grid.416009.a, Department of Orthopaedic Surgery, Faculty of Medicine, , Siriraj Hospital, Mahidol University, ; Bangkok, Thailand
                [3 ]GRID grid.412937.a, ISNI 0000 0004 0641 5987, Centre for Metabolic Bone Diseases, , Northern General Hospital, University of Sheffield, ; Herries Road, Sheffield, S5 7AU UK
                [4 ]GRID grid.5491.9, ISNI 0000 0004 1936 9297, MRC Lifecourse Epidemiology Centre, , University of Southampton, ; Southampton, UK
                [5 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, University of Gothenburg, ; Gothenburg, Sweden
                [6 ]GRID grid.411958.0, ISNI 0000 0001 2194 1270, Australian Catholic University, ; Melbourne, Australia
                [7 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Oxford NIHR Biomedical Research Centre, , University of Oxford, ; Windmill Road, Oxford, OX3 7LD UK
                [8 ]GREMPAL (Grup de Recerca en Malalties Prevalents de L’Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007 Barcelona, Spain
                [9 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Department of Clinical Research, Odense Patient Data Exploratory Network, , University of Southern Denmark, ; Odense, Denmark
                [10 ]GRID grid.414289.2, ISNI 0000 0004 0646 8763, Department of Medicine, , Holbæk Hospital, ; Holbæk, Denmark
                [11 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Medicine, Michael G DeGroote School of Medicine, , St Joseph’s Healthcare-McMaster University, ; Hamilton, ON Canada
                [12 ]GRID grid.512444.2, ISNI 0000 0004 7413 3148, Quantify Research, ; Stockholm, Sweden
                [13 ]Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
                [14 ]GRID grid.4861.b, ISNI 0000 0001 0805 7253, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, , University of Liège, ; Liège, Belgium
                [15 ]GRID grid.6142.1, ISNI 0000 0004 0488 0789, School of Medicine, , National University of Ireland Galway, ; Galway, Ireland
                [16 ]GRID grid.412440.7, ISNI 0000 0004 0617 9371, Department of Rheumatology, , Galway University Hospitals, ; Galway, Ireland
                [17 ]GRID grid.9486.3, ISNI 0000 0001 2159 0001, Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, , Universidad Nacional Autónoma de México, UNAM, ; Mexico City, Mexico
                [18 ]GRID grid.419651.e, ISNI 0000 0000 9538 1950, Hospital Universitario Fundación Jiménez Díaz, ; Madrid, Spain
                [19 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Department of Internal Medicine, Division of Endocrinology and Diabetology, , Medical University of Graz, ; Graz, Austria
                [20 ]GRID grid.8194.4, ISNI 0000 0000 9828 7548, Carol Davila University of Medicine, ; Bucharest, Romania
                [21 ]GRID grid.418526.c, ISNI 0000 0004 4690 5307, Department of Endocrinology & Bone Metabolism, , National Institute of Endocrinology, ; Bucharest, Romania
                [22 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Health Services Research, CAPHRI Care and Public Health Research Institute, , Maastricht University, ; Maastricht, the Netherlands
                [23 ]GRID grid.5342.0, ISNI 0000 0001 2069 7798, Center for Microsystems Technology, , Imec and Ghent University, ; 9050 Ghent, Belgium
                [24 ]GRID grid.419992.e, ISNI 0000 0004 7643 3099, New Mexico Clinical Research & Osteoporosis Center, ; Albuquerque, NM USA
                [25 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, , Amsterdam UMC, Vrije Universiteit Amsterdam, ; Amsterdam, the Netherlands
                [26 ]Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland
                [27 ]IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy
                [28 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Medicine, , McMaster University, ; Hamilton, ON Canada
                [29 ]GERAS Centre for Aging Research, Hamilton, ON Canada
                [30 ]GRID grid.50956.3f, ISNI 0000 0001 2152 9905, Cedars-Sinai Medical Center, ; Los Angeles, CA USA
                [31 ]Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria Spain
                [32 ]INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
                [33 ]GRID grid.26999.3d, ISNI 0000 0001 2151 536X, Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, , University of Tokyo, ; Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655 Japan
                Article
                1117
                10.1007/s11657-022-01117-6
                9239944
                35763133
                f2d28339-7c48-47b5-aa3a-1ee33bc91e90
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits 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/4.0/.

                History
                : 29 April 2022
                : 3 May 2022
                Funding
                Funded by: Medical Research Foundation
                Award ID: MRF-145-0011-DG-HARV-C0913
                Award Recipient :
                Categories
                Position Paper
                Custom metadata
                © International Osteoporosis Foundation and National Osteoporosis Foundation 2022

                Orthopedics
                fracture risk,screening,frax,treatment,cost-effectiveness
                Orthopedics
                fracture risk, screening, frax, treatment, cost-effectiveness

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