Archives of Osteoporosis(2023)18:71http5/doi.org/10.1007/s11657-023-01258-2ORIGINAL ARTICLEGRADE-ADOLOPMENT of clinical practice guidelinefor postmenopausal osteoporosis management-a Pakistani contextSarah Nadeem12.Alina Pervez'.Muhammad Abbas Abid3.Rehab Naeem Khalid4.Nashia Ali Rizvi'.Salima Saleem Aamdani2.Bushra Ayub5.Mohsin Ali Mustafa'.Sibtain Ahmed3.Mehmood Riaz2.Khadija Irfan.Shahryar Noordin?.Lena Jafri3.Hafsa Majid3.Masood Umer?.Nawazish Zehra3.Aisha Sheikh2.Adil H.Haider4.Aysha Habib Khan3Received:10 February 2023/Accepted:25 April 2023International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation 2023AbstractSummary Due to its high prevalence,we aimed to create postmenopausal osteoporosis clinical practice guideline viaGRADE-ADOLOPMENT for Pakistan.We recommend a higher dose(2000-4000 IU)of vitamin D for osteoporotic patientswho are old,have malabsorption,or are obese.The guideline will help standardize care provision and improve health careoutcomes for osteoporosis.Purpose Postmenopausal osteoporosis affects one in every five postmenopausal women in Pakistan.An evidence-basedclinical practice guideline(CPG)is needed to standardize care provision to optimize health outcomes.Hence,we aimed todevelop CPG for the management of postmenopausal osteoporosis in Pakistan.Methods The GRADE-ADOLOPMENT process was used to adopt (as is or with minor changes),exclude (omit),or adapt(modify based on local context)recommendations to the source guideline(SG)-clinical practice guidelines for the diagnosisand treatment of postmenopausal osteoporosis-2020 update from American Association of Clinical Endocrinology (AACE).Results The SG was "adoloped"to cater to the local context.The SG consisted of 51 recommendations.Forty-five recom-mendations were adopted as is.Due to unavailability of drugs,4 recommendations were adopted with minor changes,andone was excluded,while one recommendation was adopted with the inclusion of use of a surrogate FRAX tool specific forPakistan.One recommendation regarding vitamin D dosage was adapted to recommend a dose of 2000-4000 IU of vitaminD in patients with obesity,malabsorption,and old age.Conclusion The developed Pakistani postmenopausal osteoporosis guideline consists of 50 recommendations.The guidelinecreated recommends a higher dose (2000-4000 IU)of vitamin D for patients who are old,have malabsorption,or are obese,which is an adaptation from the SG by the AACE.This higher dose is justified as lower doses prove to be suboptimal inthese groups and should be complemented with baseline vitamin D and calcium levels.Keywords Postmenopausal.Osteoporosis Management.Clinical practice guideline.GRADE-ADOLOPMENT.Pakistan☒Aysha Habib Khan4 Medical College,Aga Khan University,Karachi,Pakistanaysha.habib@aku.edu5 Learning Research Centre,Patel Hospital,Karachi,PakistanCenter for Clinical Best Practices.Clinical and TranslationalDepartment of Medicine.Services Institute of MedicalResearch Incubator,Aga Khan Univ
