Vol 68, No 5 (2017)
Review paper
Published online: 2017-11-03

open access

Page views 8107
Article views/downloads 3304
Get Citation

Connect on Social Media

Connect on Social Media

Guidelines for the diagnosis and management of osteoporosis in Poland : Update 2017

Roman Lorenc, Piotr Głuszko, Edward Franek, Mirosław Jabłoński, Maciej Jaworski, Ewa Kalinka-Warzocha, Elzbieta Karczmarewicz, Tomasz Kostka, Krystyna Księzopolska-Orłowska, Ewa Marcinowska-Suchowierska, Waldemar Misiorowski, Andrzej Więcek
Pubmed: 29168548
Endokrynol Pol 2017;68(5):604-609.


In the rapidly ageing society in Poland, osteoporosis is a growing epidemiological problem, and osteoporosis-related fractures are a cause of chronic disability and considerable increase of death risk. It turns out that 80 to 90% of patients suffering from osteoporosis, including osteoporosis accompanied by fractures, do not receive adequate pharmacotherapy. In this paper, a Guideline Working Group of experts from the Multidisciplinary Osteoporosis Forum update the existing Polish guidelines concerning the diagnosis and management of osteoporosis (last revised in 2013), taking account of the latest literature, availability and reimbursement of drugs, and current health care organisation. In the revised guidelines, we still postulate that tasks are divided between primary care doctors (stage I) and specialists in osteoporosis management (stage II). We emphasise the necessity of early initiation of pharmacotherapy and rehabilitation in all patients with low-energy fractures. We recommend that the 10-year fracture risk should be estimated in all patients (including those without fractures) who are over 50 years of age, and that the Polish threshold for therapeutic intervention should be adopted: ≥ 10% for FRAX PL calculator. We add strategies of drug choice and therapy monitoring with imaging, and densitometric and biochemical diagnostics. We define basic guidelines concerning prevention of falls, rehabilitation, and dietary procedures, and elimination of environmental and other fracture risk factors. We point to two vital elements for improving osteoporosis management: 1) strategy of supervision over fractures management — Fracture Liaison Service (FLS), and, optimally, 2) strategies of short-term monitoring of the therapeutic efficacy with the use of biochemical markers.

Article available in PDF format

View PDF Download PDF file


  1. Svedbom A, Hernlund E, Ivergård M, et al. EU Review Panel of IOF. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013; 8: 137.
  2. Marcinowska-Suchowierska E, Głuszko P, Badurski J, et al. Leczenie farmakologiczne osteoporozy w Polsce — dostępność, przyczyny braku jej wdrażania. Post Nauk Med. 2015; 12: 879–885.
  3. Lorenc R, Głuszko P, Karczmarewicz E, et al. Zalecenia postępowania diagnostycznego i leczniczego w osteoporozie. Aktualizacja 2013. Medycyna Praktyczna, wyd. specj. Reumatologia. 2013; 1.
  4. Głuszko P, Lorenc RS, Karczmarewicz E, et al. Working Group including the representatives of the Polish Associations of Orthopedics and Traumatology, Rehabilitation, Gerontology, Rheumatology, Family Medicine, Diabetology, Laboratory Diagnostics, Andropause and Menopause, Endocrinology, Radiology, and the STENKO group. Polish guidelines for the diagnosis and management of osteoporosis: a review of 2013 update. Pol Arch Med Wewn. 2014; 124(5): 255–263.
  5. Kanis JA, McCloskey EV, Johansson H, et al. Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013; 24(1): 23–57.
  6. Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2017; 76(5): 802–810.
  7. Cosman F, de Beur SJ, LeBoff MS, et al. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014; 25(10): 2359–2381.
  8. Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016; 31(1): 16–35.
  9. Leszczynski P, Korkosz M, Pawlak-Bus K, et al. Diagnostyka i leczenie osteoporozy — zalecenia Polskiego Towarzystwa Reumatologicznego 2015. Forum Reumatologiczne. 2015; 1(1): 12–24.
  10. McClung MR. Cancel the denosumab holiday. Osteoporos Int. 2016; 27(5): 1677–1682.
  11. Siris ES, Adler R, Bilezikian J, et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int. 2014; 25(5): 1439–1443.
  12. Kanis JA, McCloskey EV, Harvey NC, et al. Intervention Thresholds and the Diagnosis of Osteoporosis. J Bone Miner Res. 2015; 30(10): 1747–1753.
  13. Kanis J, Harvey N, Cooper C, et al. A systematic review of intervention thresholds based on FRAX. Arch Osteoporos. 2016; 11(1).
  14. Małdyk P, Górecki A, Czerwinski E. Zasady profilaktyki, rozpoznawania i leczenia osteoporotycznych złamań kości. Ortopediia Traumatologia Rehabilitacja. 2012; 14(1 [6]): 95–101.
  15. Cosman F, de Beur SJ, LeBoff MS, et al. Erratum to: Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2015; 26(7): 2045–2047.
  16. Morris HA, Eastell R, Jorgensen NR, et al. IFCC-IOF Working Group for Standardisation of Bone Marker Assays (WG-BMA). Clinical usefulness of bone turnover marker concentrations in osteoporosis. Clin Chim Acta. 2017; 467: 34–41.
  17. Obermayer-Pietsch B, Schwetz V. [Biochemical markers of bone metabolism and their importance]. Z Rheumatol. 2016; 75(5): 451–458.
  18. Vasikaran SD, Chubb SA. The use of biochemical markers of bone turnover in the clinical management of primary and secondary osteoporosis. Endocrine. 2016; 52(2): 222–225.
  19. Roberts J, Castro C, Moore AEB, et al. Changes in bone mineral density and bone turnover in patients on 'drug holiday' following bisphosphonate therapy: real-life clinic setting. Clin Endocrinol (Oxf). 2016; 84(4): 509–515.
  20. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39(4): 412–423.
  21. Fried LP, Tangen CM, Walston J, et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3): M146–M156.
  22. Saliba D, Elliott M, Rubenstein LZ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001; 49(12): 1691–1699.
  23. D'Amelio P, Isaia GC, D'Amelio P, et al. Male Osteoporosis in the Elderly. Int J Endocrinol. 2015; 2015: 907689.
  24. Watts NB, Adler RA, Bilezikian JP, et al. Endocrine Society. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97(6): 1802–1822.
  25. Langdahl BL, Teglbjærg CS, Ho PR, et al. A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: results from the ADAMO trial. J Clin Endocrinol Metab. 2015; 100(4): 1335–1342.
  26. Diez-Perez A, Adachi JD, Agnusdei D, et al. IOF CSA Inadequate Responders Working Group. Treatment failure in osteoporosis. Osteoporos Int. 2012; 23(12): 2769–2774.
  27. Leder BZ, Tsai JN, Uihlein AV, et al. Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): extension of a randomised controlled trial. Lancet. 2015; 386(9999): 1147–1155.
  28. Lekamwasam S, Adachi JD, Agnusdei D, et al. Joint IOF-ECTS GIO Guidelines Working Group. A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int. 2012; 23(9): 2257–2276.
  29. Marcinowska-Suchowierska E. Suplementacja wapnia i witaminy D w zapobieganiu złamaniom osteoporotycznym u osób starszych. Korzyści i kontrowersje. In: Czerwiński E. ed. Osteoporoza. Problem interdyscyplinarny. PZWL, Warszawa 2015: 136–145.
  30. Płudowski P, Misiorowski W, Konstantynowicz J, et al. Profilaktyka i leczenie niedoborów witaminy D — wybór właściwych rekomendacji. Postępy Nauk Med. 2016; 10: 738–746.
  31. Pludowski P, Holick MF, Grant WB, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2017 [Epub ahead of print].
  32. Marcinowska-Suchowierska E, Płudowski P. Vitamin D toxicity. Postępy Nauk Med. 2016; 10: 756–760.
  33. Smith MR, Kabbinavar F, Saad F, et al. Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer. J Clin Oncol. 2005; 23(13): 2918–2925.
  34. Gnant M, Hadji P. Prevention of bone metastases and management of bone health in early breast cancer. Breast Cancer Res. 2010; 12(6): 216.
  35. Rathbone EJ, Brown JE, Marshall HC, et al. AZURE Investigators. Breast-cancer adjuvant therapy with zoledronic acid. N Engl J Med. 2011; 365(15): 1396–1405.
  36. van Staa TP, Geusens P, Bijlsma JWJ, et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum. 2006; 54(10): 3104–3112.
  37. Hofbauer LC, Hamann C, Ebeling PR. Approach to the patient with secondary osteoporosis. Eur J Endocrinol. 2010; 162(6): 1009–1020.
  38. Compston J. HIV infection and bone disease. J Intern Med. 2016; 280(4): 350–358.
  39. McGinty T, Mirmonsef P, Mallon PWG, et al. Does systemic inflammation and immune activation contribute to fracture risk in HIV? Curr Opin HIV AIDS. 2016; 11(3): 253–260.
  40. Rozenberg S, Lanoy E, Bentata M, et al. ANRS 120 Fosivir Study Group. Effect of alendronate on HIV-associated osteoporosis: a randomized, double-blind, placebo-controlled, 96-week trial (ANRS 120). AIDS Res Hum Retroviruses. 2012; 28(9): 972–980.
  41. Lekamwasam S, Adachi JD, Agnusdei D, et al. Joint IOF-ECTS GIO Guidelines Working Group. A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int. 2012; 23(9): 2257–2276.
  42. Starup-Linde J, Frost M, Vestergaard P, et al. Epidemiology of Fractures in Diabetes. Calcif Tissue Int. 2017; 100(2): 109–121.
  43. Janghorbani M, Van Dam RM, Willett WC, et al. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007; 166(5): 495–505.
  44. Gonnelli S, Caffarelli C, Giordano N, et al. The prevention of fragility fractures in diabetic patients. Aging Clin Exp Res. 2015; 27(2): 115–124.
  45. Kurra S, Fink DA, Siris ES. Osteoporosis-associated fracture and diabetes. Endocrinol Metab Clin North Am. 2014; 43(1): 233–243.
  46. Ko YJ, Kim JiY, Lee J, et al. Levothyroxine dose and fracture risk according to the osteoporosis status in elderly women. J Prev Med Public Health. 2014; 47(1): 36–46.
  47. Zanocco KA, Yeh MW. Primary Hyperparathyroidism: Effects on Bone Health. Endocrinol Metab Clin North Am. 2017; 46(1): 87–104.
  48. Tournis S, Fakidari E, Dontas I, et al. Effect of parathyroidectomy versus risedronate on volumetric bone mineral density and bone geometry at the tibia in postmenopausal women with primary hyperparathyroidism. J Bone Miner Metab. 2014; 32(2): 151–158.
  49. Tóth M, Grossman A. Glucocorticoid-induced osteoporosis: lessons from Cushing's syndrome. Clin Endocrinol (Oxf). 2013; 79(1): 1–11.
  50. Chiodini I, Vainicher CE, Morelli V, et al. MECHANISMS IN ENDOCRINOLOGY: Endogenous subclinical hypercortisolism and bone: a clinical review. Eur J Endocrinol. 2016; 175(6): R265–R282.
  51. Dutta D, Dharmshaktu P, Aggarwal A, et al. Severity and pattern of bone mineral loss in endocrine causes of osteoporosis as compared to age-related bone mineral loss. J Postgrad Med. 2016; 62(3): 162–169.
  52. Özbek MN, Demirbilek H, Baran RT, et al. Bone Mineral Density in Adolescent Girls with Hypogonadotropic and Hypergonadotropic Hypogonadism. J Clin Res Pediatr Endocrinol. 2016; 8(2): 163–169.
  53. Ketteler M, Leonard MB, et al. KDIGO 2016. Clinical practice guideline. Update on diagnosis, evaluation, prevention and treatment of CKD-MBD, Kidney Int. ; 2016.
  54. Walicka M, Franek E, Marcinowska-Suchowierska E. Operacja bariatryczna — i co dalej? Trendy w Endokrynologii. 2015; 3(1): 11–16.
  56. Reginster JY. Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs. 2011; 71(1): 65–78.