Value and Validation of RCOST and TOPF Clinical
Practice Guideline for Osteoporosis Treatment
Chatlert Pongchaiyakul MD*,
Taninnit Leerapun MD**, Sunton Wongsiri MD***,
Thawee Songpattanasilp MD, PhD****, Nimit Taechakraichana MD*****
Affiliation :
* Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine,
Khon Kaen University, Khon Kaen, Thailand
** Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*** Department of Orthopaedics and Physical Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
**** Department of Orthopaedics, Phramongkutklao College of Medicine Phramongkutklao Hospital, Bangkok, Thailand
***** Menopausal Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
Objective : To determine the percentage of postmenopausal women who need treatment using the various criteria as set out
in clinical practice guideline published by the Royal College of Orthopaedic Surgeons of Thailand (RCOST) and the Thai
Osteoporosis Foundation (TOPF).
Material and Method: A cross-sectional investigation conducted at five university hospitals around Thailand, evaluated
three categories of criteria according to the RCOST and the TOPF guideline for treatment in postmenopausal women,
(1) bone mineral density (BMD) measured by DXA, (2) combined quantitative ultrasonography (QUS) measurement and
clinical risk indices (CRI), and (3) FRAX or CRI plus spine radiography.
Results : One thousand sixty two woman averaging 60 years of age were recruited for this study. Of those, women with
osteoporosis according to DXA, osteopenia plus FRAX, or one major or two minor risk factors comprised between 1 and
22% (category I). Using the QUS T-score in combination with CRI (OSTA or KKOS score ≤ -1) or nomogram criteria,
between 11 and 14.4% needed treatment (category II). Using the BMI-based FRAX calculation or CRI (OSTA score of
< -4 or KKOS probability of ≥ 80%) plus osteopenia by spine radiograph, between 2.6 and 15.7% needed treatment
(category III).
Conclusion : Using the RCOST and TOPF clinical practice guideline, only one-fifth of postmenopausal Thai women would
be eligible to receive treatment.
Keywords : Clinical practice guideline, Osteoporosis, Treatment, Thailand
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