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Peer-reviewedCC BY 4.0Frontiers in Endocrinology

Quality of osteoporosis management guidelines produced in China: a systematic review

  • Xiaonan Liu1
  • Mengya Ge2
  • Caie Wu3
  • Kai Shen3
  • Jin Yang4
  • Shunxia Sun3
4 affiliations
  1. 1Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
  2. 2Public Health Department, Chongqing University Three Gorges Hospital
  3. 3Department of Spine Surgery, Chongqing General Hospital
  4. 4Department of Critical Care Medicine, Chongqing General Hospital
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Abstract

Introduction: This study employed the AGREE II and AGREE-REX instruments to assess the methodological rigor and recommendation quality of Chinese clinical practice guidelines (CPGs) for osteoporosis care.

Methods: A systematic search was conducted across CNKI, SinoMed, Wanfang, VIP, Medlive, and the Chinese Medical Association website for CPGs published between January 2014 and December 2025. AGREE II was used to evaluate methodological quality, while AGREE-REX was applied to guidelines scoring ≥50% in at least three AGREE II domains.

Results: A total of 13 CPGs were analyzed. The median overall quality score was 54% (IQR: 49%–71%). The rigor of development domain scored the lowest [38% (25%–94%)], whereas stakeholder involvement and clarity of presentation scored the highest [72% (44%–72%) and 72% (61%–83%), respectively]. Ten guidelines met the threshold for AGREE-REX assessment, with a median recommendation quality score of 56% (32%–63%). A positive correlation was found between AGREE-REX and AGREE II overall scores (r = 0.665).

Conclusions: The methodological and recommendation quality of Chinese osteoporosis CPGs is moderate. Recommendations focusing on functional assessment, diet and exercise, rehabilitation, and environmental modifications are valuable. Furthermore, traditional Chinese medicine exercises may offer a reference for CPG development in other countries.

Systematic review registration: https://ebn.nursing.fudan.edu.cn/myRegisterList , identifier, ER20240722.

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Cite

BibTeXRIS
BibTeX
@article{liu2026quality,
  title = {{Quality of osteoporosis management guidelines produced in China: a systematic review}},
  author = {Xiaonan Liu and Mengya Ge and Caie Wu and Kai Shen and Jin Yang and Shunxia Sun},
  journal = {Frontiers in Endocrinology},
  year = {2026},
  month = oct,
  doi = {10.3389/fendo.2026.1907308},
  url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1907308/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Quality of osteoporosis management guidelines produced in China: a systematic review
AU  - Xiaonan Liu
AU  - Mengya Ge
AU  - Caie Wu
AU  - Kai Shen
AU  - Jin Yang
AU  - Shunxia Sun
PY  - 2026
DA  - 2026/10/15
JO  - Frontiers in Endocrinology
DO  - 10.3389/fendo.2026.1907308
UR  - https://www.frontiersin.org/articles/10.3389/fendo.2026.1907308/full
AB  - Introduction: This study employed the AGREE II and AGREE-REX instruments to assess the methodological rigor and recommendation quality of Chinese clinical practice guidelines (CPGs) for osteoporosis care.  Methods: A systematic search was conducted across CNKI, SinoMed, Wanfang, VIP, Medlive, and the Chinese Medical Association website for CPGs published between January 2014 and December 2025. AGREE II was used to evaluate methodological quality, while AGREE-REX was applied to guidelines scoring ≥50% in at least three AGREE II domains.  Results: A total of 13 CPGs were analyzed. The median overall quality score was 54% (IQR: 49%–71%). The rigor of development domain scored the lowest [38% (25%–94%)], whereas stakeholder involvement and clarity of presentation scored the highest [72% (44%–72%) and 72% (61%–83%), respectively]. Ten guidelines met the threshold for AGREE-REX assessment, with a median recommendation quality score of 56% (32%–63%). A positive correlation was found between AGREE-REX and AGREE II overall scores (r = 0.665).  Conclusions: The methodological and recommendation quality of Chinese osteoporosis CPGs is moderate. Recommendations focusing on functional assessment, diet and exercise, rehabilitation, and environmental modifications are valuable. Furthermore, traditional Chinese medicine exercises may offer a reference for CPG development in other countries.  Systematic review registration: https://ebn.nursing.fudan.edu.cn/myRegisterList , identifier, ER20240722.
SN  - 1664-2392
ER  -