[Management of osteoporosis in short-term geriatric units].

OBJECTIVE: To identify the recommendations in Canadian and American clinical practice guidelines for the management of osteoporosis that are applicable to vulnerable, older patients in short-term geriatric units (STGU).
DESIGN: Modified Delphi approach according to the RAND/UCLA method.
SETTING: A panel of experts from various regions of Quebec. PARTICIPANTS: The panel consisted of 6 physicians, 5 pharmacists, and 3 nutritionists recognized by their peers for their expertise in STGU.
METHODS: Eleven recommendations from the North American guidelines were submitted to a panel of experts who were asked to identify those most appropriate for the management of osteoporosis in STGU. Each expert's level of agreement with the recommendations and the experts' general level of agreement were used to determine the relevance of the recommendations.
FINDINGS: The experts reached a consensus on each of the 11 recommendations. Seven recommendations were deemed appropriate for the management of osteoporosis in vulnerable, older patients in STGU. Bone mineral density measurement as a parameter for follow-up was the only recommendation deemed inappropriate in this context. The experts remained uncertain about 3 recommendations: systematic screening for osteoporosis by bone mineral density measurement; systematic screening or evaluation of the risk factors for fractures; and pharmacologic prevention in vulnerable, older patients with an increased risk of fracture.
CONCLUSION: Some of the recommendations issued in the North American recommendations appear to be less appropriate for managing osteoporosis in vulnerable, older patients in STGU. The recommendations retained in this study could be used to standardize interventions for these patients and to determine the extent to which current practice follows the recommendations.