Rehabilitative good clinical practice in the treatment of osteoporosis: a comprehensive review of clinical evidences

Purpose: Clinical practice guidelines (CPGs) are essential for guiding rehabilitation interventions. However, CPGs specifically addressing rehabilitation for osteoporosis patients remain scarce in the literature. This review aims to present, compare, and summarize recent guidelines and evidence, highlighting best practices in osteoporosis rehabilitation management. Materials and Methods: A total of 19 guidelines were identified following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three independent appraisers assessed the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation version II (AGREE II) instrument. Standardized domain and overall quality scores were calculated, and intraclass correlation coefficients (ICCs) were used to assess the level of agreement among the appraisers. Results: Agreement among appraisers for AGREE II scores ranged from moderate to very good (ICC = 0.60 to 0.90). The quality of the included CPGs varied significantly, with AGREE sub-scores ranging from 48.25% to 75.73%. The Level of Evidence (LoE) and Grade of Recommendation (GoR) differed across the guidelines included in this review. Information on exercise types, intensity, frequency, duration, and contraindications were inconsistent among CPGs. Conclusions: Recommendations regarding exercise parameters were often vague and inconsistent between CPGs, necessitating critical evaluation by healthcare providers when making clinical decisions.