BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

METHODOLOGY

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

RESULTS

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

CONCLUSION

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

Human ; Philippines ; Guideline ; Osteoporosis

Transverse vaginal septum is a rare Mullerian anomaly which is related to vertical fusion disorder. It is an uncommon anomaly that is not associated with a well-defined inheritance pattern. The vase majority of these obstructed mullerian duct abnormalities are first seen at puberty. Hematocolpos, hematometra and hematometrocolpos are some of its most common presentations. Some authors have suggested that retrograde flow through the uterus and falopian tubes could have occured earlier. It may even present before puberty. Transverse vaginal septum is infrequently associated with genitourinary tract, gastrointestinal tract, musculoskeletal, and cardiac malformations. However, it is still prudent to work up patients of the possibility of having any concomitant anomaly. The differential diagnosis of transverse vaginal septum includes imperforate hymen, Mayer-Rokitansky-Kuster-Hauser syndrome and vaginal agenesis. The complex anatomy of mullerian duct anomalies requires complete evaluation before surgical repair which would entail the use of magnetic resonance imaging, pelvic sonographic and computed tomography. In a study by Thabet, et al. in 2002, a newer modality, sonocolpography can be used to evaluate transverse vaginal septum and other allied conditions. Treatment is surgical. This presentation aims to refocus attention to the disease by reviewing the case of a 14 year old female who presented with cyclical pain and primary amenorrhea.
Human ; Female ; Adolescent ; MULLERIAN DUCTS ; ABNORMALITIES ; ENDOMETRIOSIS ;