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Management of bone health in women with premature ovarian insufficiency: Systematic appraisal of clinical practice guidelines and algorithm development

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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Velislava Kiriakova
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Affiliations
    Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Shamil D. Cooray
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Affiliations
    Department of Endocrinology, Monash Health, Clayton, Victoria, Australia

    Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Ladan Yeganeh
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    Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Gowri Somarajah
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    Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Frances Milat
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
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    Department of Endocrinology, Monash Health, Clayton, Victoria, Australia

    Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia

    Hudson Institute of Medical Research, Clayton, Victoria, Australia
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    1 Equal senior authors.
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    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Amanda J. Vincent
    Correspondence
    Corresponding author.
    Footnotes
    1 Equal senior authors.
    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
    Affiliations
    Department of Endocrinology, Monash Health, Clayton, Victoria, Australia

    Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
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  • Author Footnotes
    1 Equal senior authors.
    2 Postal address for all authors: Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.

      Highlights

      • Premature ovarian insufficiency (POI) is associated with an increased risk of osteoporosis.
      • AGREE II evaluation indicates variable quality of clinical guidelines regarding bone health management in women with POI.
      • There is a paucity of high-quality evidence to guide management.
      • Hormone replacement therapy (unless contraindicated) at least until the age of usual menopause is recommended for POI.

      Abstract

      Background

      Osteoporosis is a key concern of women with premature ovarian insufficiency (POI) but there are gaps in clinicians’ knowledge of bone health.

      Objectives

      1) To systematically evaluate the quality of clinical practice guidelines (CPGs) related to POI and bone health; 2) to formulate a management algorithm.

      Methods

      Systematic search for English-language clinical practice guidelines (CPGs) from August 2012 to August 2017 (PROSPERO registration number CRD42017075143). Four reviewers independently evaluated the methodological quality of included CPGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument (comprising 23 items across 6 domains) using the My AGREE PLUS platform. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Individual domain and total percentage scores were calculated for each CPG. Data from high-scoring CPGs were extracted and summarised to develop the algorithm, with subsequent refinement via expert and end-user clinician feedback.

      Results

      The systematic search yielded 16 CPGs for appraisal. ICC values were 0.71 (good) to 0.95 (very good). The quality of the CPGs was appraised as “high” in 4 cases, “average” in 8 and “low” in 4. High-quality CPGs had mean total scores of 82–96%. Recommendations from high-quality CPGs were summarised into 6 categories: screening; risk factors; initial assessment; diagnosis; subsequent assessment; and management. Only “management” had recommendations (moderate-quality to low-quality evidence) from all four high-quality CPGs. Limitations are reflected in the algorithm.

      Conclusions

      Most CPGs regarding bone health and POI are of average to poor quality. High-quality CPGs have evidence limitations and recommendation gaps indicating the need for further research.

      Keywords

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