A summary of the Malaysian Clinical Practice Guidelines on the management of postmenopausal osteoporosis, 2022

Objectives@#The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP). @*Methods@#A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation. @*Results@#This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate. @*Conclusions@#The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.

Management of prediabetes in Malaysian population: An experts’ opinion

@#Introduction: Prediabetes, typically defined as blood glucose levels above normal but below diabetes thresholds, denotes a risk state that confers a high chance of developing diabetes. Asians, particularly the Southeast Asian population, may have a higher genetic predisposition to diabetes and increased exposure to environmental and social risk factors. Malaysia alone was home to 3.4 million people with diabetes in 2017; the figure is estimated to reach 6.1 million by 2045. Developing strategies for early interventions to treat prediabetes and preventing the development of overt diabetes and subsequent cardiovascular and microvascular complications are therefore important. Methods: An expert panel comprising regional experts was convened in Kuala Lumpur, for a one-day meeting, to develop a document on prediabetes management in Malaysia. The expert panel comprised renowned subject-matter experts and specialists in diabetes and endocrinology, primary-care physicians, as well as academicians with relevant expertise. Results: Fifteen key clinical statements were proposed. The expert panel reached agreements on several important issues related to the management of prediabetes providing recommendations on the screening, diagnosis, lifestyle and pharmacological management of prediabetes. The expert panel also proposed changes in forthcoming clinical practice guidelines and suggested that the government should advocate early screening, detection, and intensive management of prediabetes. Conclusion: This document provides a comprehensive approach to the management of prediabetes in Malaysia in their daily activities and offer help in improving government policies and the decision-making process.

Validation of the Malay version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) in Malaysia.

PURPOSE: To assess the validity and reliability of the Malay version of the Quality of Life (QOL) Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) in Malaysia. METHODS: The QUALEFFO-41 was translated from English to Malay and administered to 215 post-menopausal osteoporotic women ≥50 years who could understand Malay, at baseline and 4 weeks. The SF-36 was administered at baseline to assess convergent validity. To assess discriminative validity, patients with and without back pain were recruited. RESULTS: Confirmatory factor analysis showed that the QUALEFFO-41 had five domains. Good internal consistency was seen in all domains (0.752-0.925) except for the social activity domain (0.692). Test-retest reliability showed adequate correlation for all items (0.752-0.964, p < 0.001). Patients with back pain had significantly worse QOL compared with those without (back pain = 42.2 ± 10.9, no back pain = 33.3 ± 8.9; p < 0.001). The total QUALEFFO-41 score and the SF-36 physical and mental composite scores were significantly correlated (-0.636 and -0.529, p < 0.001, respectively). CONCLUSIONS: The Malay version of the QUALEFFO-41 was found to be a reliable and valid instrument to evaluate the QOL of osteoporotic patients in Malaysia. To enable the QUALEFFO-41 to be used in a multiracial population, further studies should look into validating other versions of the QUALEFFO-41 in Malaysia.