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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Article info
Publication history
Published online: July 31, 2019
Accepted:
July 26,
2019
Received in revised form:
June 25,
2019
Received:
April 10,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
