Multidisciplinary consensus on the management of patients with osteopenia and fracture risk in Spain.

Background: In Spain, over 3.5 million individuals are diagnosed with osteoporosis, while an even greater number are affected by osteopenia, the precursor stage of this severe condition. Unfortunately, osteoporosis and osteopenia frequently remain undetected until a fracture occurs, potentially resulting in permanent damage or even death.

Methods: To improve the management of osteopenia, a multidisciplinary task force was established, consisting of 45 experts, including patients, doctors, nurses, pharmacists, and managers from 20 scientific organisations related to this pathology. With the scientific endorsement of the Spanish Society of Healthcare Quality (SECA) and using the Delphi qualitative research method. Although there was consistent agreement across the 75 variables analysed, a clear and consolidated consensus was reached on 56 of them (75%) after two rounds of consultation.

Results: This agreement encompassed 13 variables related to general considerations, 10 of the 18 concerning diagnosis (55%), and 33 of the 44 regarding treatment (75%). Consistent agreement was reached on all issues consulted, strong consensus (≥ 80% agreement) was achieved for 50/57 variables (88%). Key recommendations highlight the importance of lifestyle modifications for people with osteopenia, including proper nutrition, fall prevention, regular physical exercise, weight control, smoking cessation, and alcohol consumption control.

Conclusions: The study concludes that the current clinical management focuses excessively on the diagnosis of osteoporosis, neglecting previous stages of low bone mineral density, such as osteopenia, bone quality, and bone tissue structure. There is limited monitoring of risk factors such as previous fractures, despite their severe consequences. Therefore, a set of general recommendations related to diagnosis and treatment is proposed to improve the management of patients with this condition.