From being an almost Cinderella subject, osteoporosis prevention and treatment has suddenly become the focus of two sets of national guidelines.
The Royal College of Physicians' guidelines have been four years in preparation, and the result is an authoritative, detailed summary of our knowledge. In contrast, the PrimaryoCare Rheumatology (PCR) Society has produced, in less than a year, a pragmatic distillate of essential ideas.
The most striking feature of these two approaches is the amount of agreement. At no time does one feel that there is any real debate as to how to proceed. Both clearly state the importance of this area of practice and we are left in no doubt that osteoporosis matters very much.
Both documents emphasise that all healthcare planning – from national to practice based – must have active osteoporosis programmes.
There is good agreement on treatment options, and both sets of guidelines are clear about the effectiveness of treatment.
The Royal College's report is 110 pages long, whereas the PCR Society's report is just two pages. This alone tells us a lot about them.
The Royal College's report is balanced and well referenced, yet it manages to escape the occasional fate of such learned documents by still giving unambiguous recommendations. They have been a little cautious in, say, advocating non-pharmacological options in the prevention of osteoporosis, but overall they are clear.
In contrast, the PCR Society's report is prepared to commit itself a little more, and the idea of putting all nursing home residents on calcium with vitamin D seems excellent. The emphasis is on achievable measures.
Although both documents deal with the risks of breast cancer in HRT well, it is the PCR Society's guidelines that convey the information most clearly.
The patient information in the PCR Society's guidelines is magnificent. The Royal College's guidelines give clear investigation protocols and draw attention to the woeful lack of dual-energy X-ray absorptiometry (DXA) scanning in this country; in contrast, the PCR Society's document deals only with the situation as it is, without bemoaning resources. It is good to see the weight of a Royal College report arguing, in financially justified terms, for better services.
Why do we need two sets of guidelines on this subject? Which is most relevant to general practice? The short answer to the latter question is 'both'.
One set – the longer – is an excellent resource which all PCGs should consider for policy making and clinical governance. It would be good for practice level use too, with enough succinct practical points to be very useful. The shorter PCR report is a gem of practicality, and since it is laminated it can usefully be kept on the desk.
Bearing in mind that more good can be done by proper implementation of existing knowledge than by new discoveries, the PCR Society's report tells us just what to do in this important area. The PCR guidelines are a masterpiece of brevity and effectiveness.