Background: Osteoporosis is a key concern of women with premature ovarian insufficiency (POI)1 and bone health knowledge gaps are reported by clinicians2.
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 CPGs from August 2012 to August 2017. Four reviewers independently evaluated the methodological quality of included CPGs with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument (comprising 23 items across 6 domains) using the My AGREE PLUS platform3. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC) (SPSS v23.0). Appraisers discussed scoring where ICC<0.70 to achieve consensus. Individual domain and total percentage scores were calculated for each CPG4. Data from high-scoring CPGs was extracted and summarised to develop the algorithm, with subsequent refinement via expert and end-user clinician feedback.
Results: Systematic search yielded 16 CPGs for appraisal. ICC values were 0.71(good) to 0.95(very good). Appraisal yielded 4 “high”, 8 “average” and 4 “low” quality CPGs. 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 to low quality evidence) from all four CPGs. Limitations are reflected in the algorithm.
Conclusions: Most CPGs regarding bone health and POI are average to poor quality. High quality CPGs have evidence limitations and recommendation gaps indicating the need for further research.