Moving from evidence to recommendations, guideline panels can influence decisions in everyday clinical practice. Consequently, guideline panellists should carefully craft their recommendations to minimise the potential for harm, including the possibility of increasing overdiagnosis and promoting overuse of unnecessary tests and treatments. This is particularly important in the context of screening and preventive healthcare because such recommendations apply to healthy individuals.

Overuse in healthcare is frequent and happens when tests or treatments are used in contexts where harms outweigh benefits. This low-value care leads to unwarranted use of resources and unhelpful diagnoses, which can in turn lead to more overuse. Overdiagnosis, one consequence of overuse, is also linked to expanding disease definitions and is a known harm of screening. Overuse and overdiagnosis have raised concerns about the sustainability of healthcare which has led to the creation of the Global Centre for Sustainable Healthcare.

In this article, we seek to raise awareness about how guidelines can help prevent overdiagnosis and overuse. We present reflections that emerged while authoring a national guideline for the primary prevention of fragility fracture1 and through follow-up discussion at the 2023 Preventing Overdiagnosis conference in Copenhagen.

Guidelines developers are well positioned to address the issues of overdiagnosis and overuse. They are, in fact, key players in any potential solution. Beyond issuing a call for more …