Interpretation of 2024 United Kingdom National Osteoporosis Guideline Group (NOGG) Clinical Guidelines: Prevention and Treatment of Osteoporosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Jiaxiang , WANG Bailiang , WANG Weiguo ,  MA Jinhui

Department of Orthopedics and Joint Surgery, China-Japan Friendship Hospital, Beijing, 100029, P. R. China;

Corresponding?author：

MA Jinhui, Email: 1402317340@qq.com

Keywords：

Osteoporosis; clinical guideline; fragility fracture; pharmacological treatment

DOI：

10.7507/1002-1892.202603052

Video：

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With the accelerating aging of the global population, osteoporosis and its associated complications have posed significant challenges to public health systems worldwide. The United Kingdom National Osteoporosis Guideline Group (NOGG) recently released the 2024 edition of its clinical guideline for the prevention and treatment of osteoporosis, underpinned by the most recent evidence-based medical data. This guideline provides comprehensive guidance on screening and assessment, pharmacological intervention strategies, and the promotion of bone health. This article offers an in-depth interpretation of the updated guideline and compares the similarities and differences between Chinese and 2024 NOGG guidelines regarding intervention thresholds, pharmacological sequencing, and efficacy monitoring. By analyzing the advanced management strategies introduced in the 2024 NOGG guideline, this paper explores its application value within the Chinese clinical context, aiming to optimize local prevention and treatment protocols and enhance the quality of long-term disease management.

Citation： GAO Jiaxiang, WANG Bailiang, WANG Weiguo, MA Jinhui. Interpretation of 2024 United Kingdom National Osteoporosis Guideline Group (NOGG) Clinical Guidelines: Prevention and Treatment of Osteoporosis. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(8): 1172-1178. doi: 10.7507/1002-1892.202603052 Copy

1.	Salari N, Ghasemi H, Mohammadi L, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis[J/OL]. J Orthop Surg Res, 2021, 16(1): 609. doi: 10.1186/s13018-021-02772-0.
2.	中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診療指南 (2022)[J]. 中國全科醫學, 2023, 26(14): 1671-1691.
3.	van Staa TP, Dennison EM, Leufkens HG, et al. Epidemiology of fractures in England and Wales[J]. Bone, 2001, 29(6): 517-522.
4.	Wang L, Yu W, Yin X, et al. Prevalence of osteoporosis and fracture in China: The China osteoporosis prevalence study [J/OL]. JAMA Netw Open, 2021, 4(8): e2121106. doi: 10.1001/jamanetworkopen.2021.21106.
5.	Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study[J/OL]. PLoS Med, 2020, 17(8): e1003180. doi: 10.1371/journal.pmed.1003180.
6.	Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010—2050[J]. Osteoporos Int, 2015, 26(7): 1929-1937.
7.	Gregson CL, Armstrong DJ, Avgerinou C, et al. The 2024 UK clinical guideline for the prevention and treatment of osteoporosis[J/OL]. Arch Osteoporos, 2025, 20(1): 119. doi: 10.1007/s11657-025-01588-3.
8.	Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of fracture probability in men and women from the UK[J]. Osteoporos Int, 2008, 19(4): 385-397.
9.	Bai J, Gao Q, Wang C, et al. Diabetes mellitus and risk of low-energy fracture: a meta-analysis[J]. Aging Clin Exp Res, 2020, 32(11): 2173-2186.
10.	Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures[J]. J Bone Miner Res, 2005, 20(7): 1185-1194.
11.	Kanis JA, Johansson H, Oden A, et al. Guidance for the adjustment of FRAX according to the dose of glucocorticoids[J]. Osteoporos Int, 2011, 22(3): 809-816.
12.	Liu SY, Huang M, Chen R, et al. Comparison of strategies for setting intervention thresholds for Chinese postmenopausal women using the FRAX model[J]. Endocrine, 2019, 65(1): 200-206.
13.	Cui L, He T, Jiang Y, et al. Predicting the intervention threshold for initiating osteoporosis treatment among postmenopausal women in China: a cost-effectiveness analysis based on real-world data[J]. Osteoporos Int, 2020, 31(2): 307-316.
14.	Kung AW, Lee KK, Ho AY, et al. Ten-year risk of osteoporotic fractures in postmenopausal Chinese women according to clinical risk factors and BMD T-scores: a prospective study[J]. J Bone Miner Res, 2007, 22(7): 1080-1087.
15.	Rogers MJ. New insights into the molecular mechanisms of action of bisphosphonates[J]. Curr Pharm Des, 2003, 9(32): 2643-2658.
16.	Papapoulos SE, Makras P. Bisphosphonates in the management of patients with postmenopausal osteoporosis; Back to the future[J/OL]. Pharmaceuticals (Basel), 2025, 18(7): 1068. doi: 10.3390/ph18071068.
17.	Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: Report of a task force of the American Society for Bone and Mineral Research[J]. J Bone Miner Res, 2016, 31(1): 16-35.
18.	McClung MR. Sequential and long-term therapy for osteoporosis[J/OL]. Curr Osteoporos Rep, 2025, 23(1): 15. doi: 10.1007/s11914-025-00909-2.
19.	Ruksakiet K, Jarusriwanna A, Sadaeng W, et al. Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis[J]. EFORT Open Rev, 2025, 10(5): 258-266.
20.	Tsourdi E. Drug holidays with bisphosphonates in osteoporosis treatment: One size does not fit all[J/OL]. J Clin Endocrinol Metab, 2025, 110(3): e899-e900.
21.	Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension[J]. Lancet Diabetes Endocrinol, 2017, 5(7): 513-523.
22.	Langdahl BL, Teglbj?rg CS, Ho PR, et al. A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: results from the ADAMO trial[J]. J Clin Endocrinol Metab, 2015, 100(4): 1335-1342.
23.	Miller PD, Wagman RB, Peacock M, et al. Effect of denosumab on bone mineral density and biochemical markers of bone turnover: six-year results of a phase 2 clinical trial[J]. J Clin Endocrinol Metab, 2011, 96(2): 394-402.
24.	Reid IR, Horne AM, Mihov B, et al. Bone loss after denosumab: Only partial protection with zoledronate[J]. Calcif Tissue Int, 2017, 101(4): 371-374.
25.	Horne AM, Mihov B, Reid IR. Effect of zoledronate on bone loss after romosozumab/denosumab: 2-year follow-up[J]. Calcif Tissue Int, 2019, 105(1): 107-108.
26.	Kendler D, Chines A, Clark P, et al. Bone mineral density after transitioning from denosumab to alendronate[J/OL]. J Clin Endocrinol Metab, 2020, 105(3): e255-e264.
27.	National Institute for Health and Care Excellence (NICE). 2019 surveillance of menopause: diagnosis and management (NICE guideline NG23)[R/OL]. (2019-12-19). https://www.nice.org.uk/guidance/ng23.
28.	El Khoudary SR, Aggarwal B, Beckie TM, et al. Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association[J/OL]. Circulation, 2020, 142(25): e506-e532.
29.	Canonico M, Plu-Bureau G, Lowe GD, et al. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis[J]. BMJ, 2008, 336(7655): 1227-1231.
30.	Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women[J/OL]. Cochrane Database Syst Rev, 2015, 2015(3): CD002229. doi: 10.1002/14651858.CD002229.pub4.
31.	Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence[J]. Lancet, 2019, 394(10204): 1159-1168.
32.	Hamoda H, Panay N, Pedder H, et al. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women[J]. Post Reprod Health, 2020, 26(4): 181-209.
33.	Reginster J-Y, Bianic F, Campbell R, et al. Abaloparatide for risk reduction of nonvertebral and vertebral fractures in postmenopausal women with osteoporosis: a network meta-analysis[J]. Osteoporos Int, 2019, 30(7): 1465-1473.
34.	Saag KG, Zanchetta JR, Devogelaer JP, et al. Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial[J]. Arthritis Rheum, 2009, 60(11): 3346-3355.
35.	Kendler DL, Marin F, Zerbini CAF, et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial[J]. Lancet, 2018, 391(10117): 230-240.
36.	Gilsenan A, Midkiff K, Harris D, et al. Teriparatide did not increase adult osteosarcoma incidence in a 15-year us postmarketing surveillance study[J]. J Bone Miner Res, 2021, 36(2): 244-251.
37.	侯艷芳, 劉建民. 新型促骨形成劑Abaloparatide的研究進展[J]. 中華骨質疏松和骨礦鹽疾病雜志, 2018, 11(3): 290-295.
38.	Miller PD, Hattersley G, Riis BJ, et al. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: A randomized clinical trial[J]. JAMA, 2016, 316(7): 722-733.
39.	Beaudart C, Veronese N, Douxfils J, et al. PTH1 receptor agonists for fracture risk: a systematic review and network meta-analysis[J]. Osteoporos Int, 2025, 36(6): 951-967.
40.	DeSapri KT, Clarke BL, Kostenuik P, et al. Effect of abaloparatide on fracture incidence and bone mineral density in postmenopausal women with osteoporosis at highest risk for fracture[J]. Menopause, 2025, 32(5): 388-395.
41.	Rauner M, Taipaleenm?ki H, Tsourdi E, et al. Osteoporosis treatment with anti-sclerostin antibodies-mechanisms of action and clinical application[J/OL]. J Clin Med, 2021, 10(4): 787. doi: 10.3390/jcm10040787.
42.	Cosman F, Crittenden DB, Adachi JD, et al. Romosozumab treatment in postmenopausal women with osteoporosis[J]. N Engl J Med, 2016, 375(16): 1532-1543.
43.	Saag KG, Petersen J, Brandi ML, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis[J]. N Engl J Med, 2017, 377(15): 1417-1427.
44.	Chiu SH, Wu WT, Yao TK, et al. Sclerostin and cardiovascular risk: Evaluating the cardiovascular safety of romosozumab in osteoporosis treatment[J/OL]. Biomedicines, 2024, 12(12): 2880. doi: 10.3390/biomedicines12122880.

1. Salari N, Ghasemi H, Mohammadi L, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis[J/OL]. J Orthop Surg Res, 2021, 16(1): 609. doi: 10.1186/s13018-021-02772-0.
2. 中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診療指南 (2022)[J]. 中國全科醫學, 2023, 26(14): 1671-1691.
3. van Staa TP, Dennison EM, Leufkens HG, et al. Epidemiology of fractures in England and Wales[J]. Bone, 2001, 29(6): 517-522.
4. Wang L, Yu W, Yin X, et al. Prevalence of osteoporosis and fracture in China: The China osteoporosis prevalence study [J/OL]. JAMA Netw Open, 2021, 4(8): e2121106. doi: 10.1001/jamanetworkopen.2021.21106.
5. Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study[J/OL]. PLoS Med, 2020, 17(8): e1003180. doi: 10.1371/journal.pmed.1003180.
6. Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010—2050[J]. Osteoporos Int, 2015, 26(7): 1929-1937.
7. Gregson CL, Armstrong DJ, Avgerinou C, et al. The 2024 UK clinical guideline for the prevention and treatment of osteoporosis[J/OL]. Arch Osteoporos, 2025, 20(1): 119. doi: 10.1007/s11657-025-01588-3.
8. Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of fracture probability in men and women from the UK[J]. Osteoporos Int, 2008, 19(4): 385-397.
9. Bai J, Gao Q, Wang C, et al. Diabetes mellitus and risk of low-energy fracture: a meta-analysis[J]. Aging Clin Exp Res, 2020, 32(11): 2173-2186.
10. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures[J]. J Bone Miner Res, 2005, 20(7): 1185-1194.
11. Kanis JA, Johansson H, Oden A, et al. Guidance for the adjustment of FRAX according to the dose of glucocorticoids[J]. Osteoporos Int, 2011, 22(3): 809-816.
12. Liu SY, Huang M, Chen R, et al. Comparison of strategies for setting intervention thresholds for Chinese postmenopausal women using the FRAX model[J]. Endocrine, 2019, 65(1): 200-206.
13. Cui L, He T, Jiang Y, et al. Predicting the intervention threshold for initiating osteoporosis treatment among postmenopausal women in China: a cost-effectiveness analysis based on real-world data[J]. Osteoporos Int, 2020, 31(2): 307-316.
14. Kung AW, Lee KK, Ho AY, et al. Ten-year risk of osteoporotic fractures in postmenopausal Chinese women according to clinical risk factors and BMD T-scores: a prospective study[J]. J Bone Miner Res, 2007, 22(7): 1080-1087.
15. Rogers MJ. New insights into the molecular mechanisms of action of bisphosphonates[J]. Curr Pharm Des, 2003, 9(32): 2643-2658.
16. Papapoulos SE, Makras P. Bisphosphonates in the management of patients with postmenopausal osteoporosis; Back to the future[J/OL]. Pharmaceuticals (Basel), 2025, 18(7): 1068. doi: 10.3390/ph18071068.
17. Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: Report of a task force of the American Society for Bone and Mineral Research[J]. J Bone Miner Res, 2016, 31(1): 16-35.
18. McClung MR. Sequential and long-term therapy for osteoporosis[J/OL]. Curr Osteoporos Rep, 2025, 23(1): 15. doi: 10.1007/s11914-025-00909-2.
19. Ruksakiet K, Jarusriwanna A, Sadaeng W, et al. Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis[J]. EFORT Open Rev, 2025, 10(5): 258-266.
20. Tsourdi E. Drug holidays with bisphosphonates in osteoporosis treatment: One size does not fit all[J/OL]. J Clin Endocrinol Metab, 2025, 110(3): e899-e900.
21. Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension[J]. Lancet Diabetes Endocrinol, 2017, 5(7): 513-523.
22. Langdahl BL, Teglbj?rg CS, Ho PR, et al. A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: results from the ADAMO trial[J]. J Clin Endocrinol Metab, 2015, 100(4): 1335-1342.
23. Miller PD, Wagman RB, Peacock M, et al. Effect of denosumab on bone mineral density and biochemical markers of bone turnover: six-year results of a phase 2 clinical trial[J]. J Clin Endocrinol Metab, 2011, 96(2): 394-402.
24. Reid IR, Horne AM, Mihov B, et al. Bone loss after denosumab: Only partial protection with zoledronate[J]. Calcif Tissue Int, 2017, 101(4): 371-374.
25. Horne AM, Mihov B, Reid IR. Effect of zoledronate on bone loss after romosozumab/denosumab: 2-year follow-up[J]. Calcif Tissue Int, 2019, 105(1): 107-108.
26. Kendler D, Chines A, Clark P, et al. Bone mineral density after transitioning from denosumab to alendronate[J/OL]. J Clin Endocrinol Metab, 2020, 105(3): e255-e264.
27. National Institute for Health and Care Excellence (NICE). 2019 surveillance of menopause: diagnosis and management (NICE guideline NG23)[R/OL]. (2019-12-19). https://www.nice.org.uk/guidance/ng23.
28. El Khoudary SR, Aggarwal B, Beckie TM, et al. Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association[J/OL]. Circulation, 2020, 142(25): e506-e532.
29. Canonico M, Plu-Bureau G, Lowe GD, et al. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis[J]. BMJ, 2008, 336(7655): 1227-1231.
30. Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women[J/OL]. Cochrane Database Syst Rev, 2015, 2015(3): CD002229. doi: 10.1002/14651858.CD002229.pub4.
31. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence[J]. Lancet, 2019, 394(10204): 1159-1168.
32. Hamoda H, Panay N, Pedder H, et al. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women[J]. Post Reprod Health, 2020, 26(4): 181-209.
33. Reginster J-Y, Bianic F, Campbell R, et al. Abaloparatide for risk reduction of nonvertebral and vertebral fractures in postmenopausal women with osteoporosis: a network meta-analysis[J]. Osteoporos Int, 2019, 30(7): 1465-1473.
34. Saag KG, Zanchetta JR, Devogelaer JP, et al. Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial[J]. Arthritis Rheum, 2009, 60(11): 3346-3355.
35. Kendler DL, Marin F, Zerbini CAF, et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial[J]. Lancet, 2018, 391(10117): 230-240.
36. Gilsenan A, Midkiff K, Harris D, et al. Teriparatide did not increase adult osteosarcoma incidence in a 15-year us postmarketing surveillance study[J]. J Bone Miner Res, 2021, 36(2): 244-251.
37. 侯艷芳, 劉建民. 新型促骨形成劑Abaloparatide的研究進展[J]. 中華骨質疏松和骨礦鹽疾病雜志, 2018, 11(3): 290-295.
38. Miller PD, Hattersley G, Riis BJ, et al. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: A randomized clinical trial[J]. JAMA, 2016, 316(7): 722-733.
39. Beaudart C, Veronese N, Douxfils J, et al. PTH1 receptor agonists for fracture risk: a systematic review and network meta-analysis[J]. Osteoporos Int, 2025, 36(6): 951-967.
40. DeSapri KT, Clarke BL, Kostenuik P, et al. Effect of abaloparatide on fracture incidence and bone mineral density in postmenopausal women with osteoporosis at highest risk for fracture[J]. Menopause, 2025, 32(5): 388-395.
41. Rauner M, Taipaleenm?ki H, Tsourdi E, et al. Osteoporosis treatment with anti-sclerostin antibodies-mechanisms of action and clinical application[J/OL]. J Clin Med, 2021, 10(4): 787. doi: 10.3390/jcm10040787.
42. Cosman F, Crittenden DB, Adachi JD, et al. Romosozumab treatment in postmenopausal women with osteoporosis[J]. N Engl J Med, 2016, 375(16): 1532-1543.
43. Saag KG, Petersen J, Brandi ML, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis[J]. N Engl J Med, 2017, 377(15): 1417-1427.
44. Chiu SH, Wu WT, Yao TK, et al. Sclerostin and cardiovascular risk: Evaluating the cardiovascular safety of romosozumab in osteoporosis treatment[J/OL]. Biomedicines, 2024, 12(12): 2880. doi: 10.3390/biomedicines12122880.

Chinese Journal of Reparative and Reconstructive Surgery

Interpretation of 2024 United Kingdom National Osteoporosis Guideline Group (NOGG) Clinical Guidelines: Prevention and Treatment of Osteoporosis

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