As our population continues to age, osteoporosis and osteoporosis related fragility fractures will increase in frequency. The disease disproportionately affects women. Over 50% of women and 20% of men will experience an osteoporosis-related fracture during their lifetime. The consequences of these fractures are sobering. Nearly 20% of patients will die within 6 months of a hip fracture, 20% will require permanent nursing home care. Only 50% will regain their prior level of functioning. With the advent of bone density screening, osteoporosis can be readily detected. The USPSTF recommends screening women at average risk at age 65. Numerous treatments for the prevention and treatment of osteoporosis are now available and include oral and IV bisphosphonates such as alendronate and zoledronic acid, selective estrogen receptor modulators (SERMs) such as raloxifene and anabolics such as teriparatide. Additionally, some groups still advocate for the use of calcium and vitamin D; whereas, the USPSTF does not.
For providers looking for mobile apps for the treatment of osteoporosis using the most evidence-based recommendations, we still would recommend any of our first line general medical reference apps such as Dynamed/Dynamed Plus, UpToDate, or Essential Evidence. However, for quick access to current osteoporosis information the only app is FRAX which is really just a risk calculator. Two online guidelines include the recently released ACP guideline on osteoporosis and the 2016 AACE osteoporosis guideline. The former is more evidence-based, the later more expert-based. The AACE have provided a very intuitive app as a companion to their guideline. Previously we favorably reviewed (with some EBM based reservations) their AACE 2016 Diabetes Algorithm and their Accurate Insulin Decisions apps. Their new 2016 AACE Osteoporosis Algorithm app contains numerous sections on the prevention, diagnosis, treatment and follow-up of osteoporosis with extensive information on both oral and injectable medications.
Evidence based medicine
The app delivers evidence-based and expert/consensus-based overview of osteoporosis diagnosis, treatment and follow-up. The app is well referenced and provides content any medical student up to seasoned attending could benefit from having available at the tips of their fingers. The fact that the app relies heavily on expert/consensus opinion and the AACE receives drug company funding cannot be overstated.
Who would benefit from this App?
Any healthcare provider who cares for patients with/at risk for osteoporosis including students, NP’s, PA’s, interns/residents in primary care specialties including internal medicine, family medicine, geriatrics, and endocrinology.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Responsive user interface with built in algorithms and quick reference section.
- Comprehensive, well-referenced content covering a wide range of osteoporosis topics.
- Easy to follow algorithms and treatment recommendations.
- Available for Android.
- Some recommendations clearly expert/consensus opinion.
- AACE is partially funded by various drug companies.
- No disclaimer on app for above, but online documents show conflicts of interest.
AACE 2016 Osteoporosis Algorithm app is comprehensive, produced by a reliable source and is an nice addition to both iOS and Android for providers who treat patients with/at risk for osteoporosis. However, the AACE is partially funded by numerous drug companies and the app states the use of expert opinion and/or consensus where clear evidence was not available. Some of the practice recommendations are in opposition to those from other groups including the USPSTF, AAFP, and ACP. The informed provider will have to decide how aggressively they plan to follow the algorithms described in the app. The app contains very simple to follow algorithms that many providers will find very useful.
- Overall Score
- User Interface
Intuitive interface with many quick reference sections and detailed algorithms with expandable content.
- Multimedia Usage
The app contains many charts, algorithms, references, etc. most of which are easy to use/see on the iPhone, but FRAX calculation requires a web link or you can use the FRAX app.
App is free.
- Real World Applicability
The AACE Osteoporosis app is the most easy to use and comprehensive standalone app on the iOS/Android app stores. However, the guidelines the app is based on are expert-based and the AACE and its various guidelines are partially funded by drug company dollars so the risk of bias is not insignificant. Nonetheless, it is a comprehensive and credible resource for providers caring for patients with/at risk for osteoporosis.
- Device Used For Review
iPhone 6S running iOS 10.3.1
- Available for DownloadAndroidiPhoneiPad