The UK National Osteoporosis Guideline Group (NOGG) has just launched its new UK Guideline for ‘The Prevention and Treatment of Osteoporosis’, which has received accreditation from the National Institute of Health and Care Excellence (NICE).
The updated Guideline reviews the assessment and diagnosis of osteoporosis, the therapeutic interventions available, and the approaches for the prevention of fragility fractures, in postmenopausal women, and in men aged 50 years or older. It can be found on the new website (www.nogg.org.uk), which also houses a range of useful resources, a two-page summary of the main recommendations, complemented by 52 frequently asked questions (FAQs) from primary and secondary care with responses from NOGG (further FAQs can be also be proposed online). Specific information about NOGG for patients and the public is also provided.
Key updates to the NOGG guidance include, among others: a greater emphasis on vertebral fracture detection; the new concept of ‘very high fracture risk’ which should prompt consideration of the use of parenteral anti-osteoporosis therapy; new guidance regarding anabolic treatment options; the urgent need to get patients with a fragility fracture onto treatment to reduce re-fracture risk with follow-up to check tolerance and ensure adherence; the use of intravenous zoledronate as a first-line anti-osteoporosis therapy; concerns regarding denosumab cessation; and intervention thresholds for patients too frail to undergo bone density scanning.
The guidance also includes recommendations regarding fracture liaison services, training of clinicians and allied health professionals, service commissioning, and criteria for audit and quality improvement in service provision.
The Fracture Risk Assessment Tool (FRAX) for the UK links directly to the new NOGG intervention thresholds and advice to guide the treatment of osteoporosis. FRAX® is a computer-based algorithm that calculates the 10-year probability of a major osteoporotic and the 10-year probability of hip fracture alone.
Lead author, Professor Celia Gregson, stated:
“The NOGG, established in 2007, is a multidisciplinary group of 20 individuals that includes patient representation and professionals involved in the care of people with osteoporosis. It has taken this team more than 18 months to review, appraise and collate the necessary evidence to write this important new guideline for primary and secondary care use. The guideline has been reviewed and supported by 18 professional and/or patient organisations in the field, including the Royal Osteoporosis Society.”
The guideline, also published as an open-access position paper in Archives of Osteoporosis, has been endorsed by the International Osteoporosis Foundation (IOF) and by the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).
Fragility fractures are a major cause of disability and loss of independence in older adults and place an enormous burden on the healthcare system. Although osteoporosis affects approximately 5.2% of the UK population, causing more than half a million new fragility fractures annually, there is an enormous treatment gap that leaves approximately 66% of women at high risk of fragility fractures untreated. 
Professor John A. Kanis, IOF Honorary President and co-author of the guideline, stated:
“Given the underdiagnosis and undertreatment of osteoporosis, it is critically important that physicians are aware of best-practice standards and the many recent advances in the field. We hope that the updated NOGG guidelines, which include recommendations for improved service provision in both primary and secondary care settings, will be widely disseminated to clinicians across the UK.”
 NOGG: Full Clinical Guideline for the Prevention and Treatment of Osteoporosis, with a summary of main recommendations and information for patients and public
 Gregson, C.L., Armstrong, D.J., Bowden, J. et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 17, 58 (2022). https://doi.org/10.1007/s11657-022-01061-5
 Willers, C., Norton, N., Harvey, N.C. et al. Osteoporosis in Europe: a compendium of country-specific reports. Arch Osteoporos 17, 23 (2022). https://doi.org/10.1007/s11657-021-00969-8
The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as more than 300 patient, medical and research organizations, work together to make fracture prevention and healthy mobility a worldwide heath care priority.