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Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis.
Endocr Pract. 2009 Sep-Oct; 15(6):573-9.EP

Abstract

OBJECTIVE

To evaluate the benefits and limitations of randomized controlled trials (RCTs), clinical practice guidelines (CPGs), and clinical judgment in the management of osteoporosis.

METHODS

A review was conducted of the English-language literature on the origins and applications of RCTs, CPGs, evidence-based medicine, and clinical judgment in the management of osteoporosis.

RESULTS

Evidence-based medicine is use of the currently available best evidence in making clinical decisions for individual patients. CPGs are recommendations for making clinical decisions based on research evidence, sometimes with consideration of expert opinion, health care policy, and costs of care. The highest levels of medical evidence are usually thought to be RCTs and meta-analyses of high-quality RCTs. Although it is desirable and appropriate for clinicians to consider research evidence from RCTs and recommendations presented in CPGs in making clinical decisions, other factors-such as patient preference, comorbidities, affordability, and availability of care-are important for the actual implementation of evidence-based medicine.

CONCLUSION

Decisions about who to treat, which drug to use, how best to monitor, and how long to treat require clinical skills in addition to knowledge of medical research. The necessity of integrating common sense and clinical judgment is highlighted by the fact that many patients treated for osteoporosis in clinical practice would not qualify for participation in the pivotal clinical trials that demonstrated efficacy and safety of the drugs used to treat them.

Authors+Show Affiliations

New Mexico Clinical Research and Osteoporosis Center, 300 Oak Street Northeast, Albuquerque, NM 87106. LEWIECKI@aol.comNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19491062

Citation

Lewiecki, E Michael, and Neil Binkley. "Evidence-based Medicine, Clinical Practice Guidelines, and Common Sense in the Management of Osteoporosis." Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 15, no. 6, 2009, pp. 573-9.
Lewiecki EM, Binkley N. Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis. Endocr Pract. 2009;15(6):573-9.
Lewiecki, E. M., & Binkley, N. (2009). Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis. Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 15(6), 573-9. https://doi.org/10.4158/EP09107.RA
Lewiecki EM, Binkley N. Evidence-based Medicine, Clinical Practice Guidelines, and Common Sense in the Management of Osteoporosis. Endocr Pract. 2009 Sep-Oct;15(6):573-9. PubMed PMID: 19491062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis. AU - Lewiecki,E Michael, AU - Binkley,Neil, PY - 2009/6/4/entrez PY - 2009/6/6/pubmed PY - 2010/1/29/medline SP - 573 EP - 9 JF - Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists JO - Endocr Pract VL - 15 IS - 6 N2 - OBJECTIVE: To evaluate the benefits and limitations of randomized controlled trials (RCTs), clinical practice guidelines (CPGs), and clinical judgment in the management of osteoporosis. METHODS: A review was conducted of the English-language literature on the origins and applications of RCTs, CPGs, evidence-based medicine, and clinical judgment in the management of osteoporosis. RESULTS: Evidence-based medicine is use of the currently available best evidence in making clinical decisions for individual patients. CPGs are recommendations for making clinical decisions based on research evidence, sometimes with consideration of expert opinion, health care policy, and costs of care. The highest levels of medical evidence are usually thought to be RCTs and meta-analyses of high-quality RCTs. Although it is desirable and appropriate for clinicians to consider research evidence from RCTs and recommendations presented in CPGs in making clinical decisions, other factors-such as patient preference, comorbidities, affordability, and availability of care-are important for the actual implementation of evidence-based medicine. CONCLUSION: Decisions about who to treat, which drug to use, how best to monitor, and how long to treat require clinical skills in addition to knowledge of medical research. The necessity of integrating common sense and clinical judgment is highlighted by the fact that many patients treated for osteoporosis in clinical practice would not qualify for participation in the pivotal clinical trials that demonstrated efficacy and safety of the drugs used to treat them. SN - 1934-2403 UR - https://www.unboundmedicine.com/medline/citation/19491062/Evidence_based_medicine_clinical_practice_guidelines_and_common_sense_in_the_management_of_osteoporosis_ L2 - http://journals.aace.com/doi/10.4158/EP09107.RA?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -