Clinical Practice Guideline: The Diagnosis and Treatment of Osteoporosis.

IF 6.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Deutsches Arzteblatt international Pub Date : 2025-01-10 DOI:10.3238/arztebl.m2024.0222

Friederike Thomasius, Andreas Kurth, Erika Baum, Michael Drey, Uwe Maus, Ralf Schmidmaier

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Abstract

Background: Osteoporosis is a common disease that affects approximately 6 million people in Germany alone. Osteoporotic fractures impair the quality of life and may make independent living impossible. Recommendations on the diagnosis and treatment of osteoporosis are indispensable for the effective care of this large group of patients.

Methods: For a thorough updating of the German clinical practice guideline (an evidence-based guideline with recommendations for clinical practice) on osteoporosis, a comprehensive, systematic search for relevant publications was carried out, including guidelines from other countries. The retrieved literature was assessed with standardized (Oxford) criteria, and clinically relevant key questions were answered according to the PICO scheme ("population, intervention, comparison, outcomes").

Results: The assessment of clinical risk factors for osteoporosis is the basis of osteoporosis diagnostics, which should be carried out quickly after a fracture. If risk factors are present in a postmenopausal woman or a man aged 50 or above, bone densitometry testing with dual-energy x-ray absorptiometry (DXA) is recommended. The further diagnostic evaluation should proceed in stepwise fashion depending on the clinical symptoms, the fracture status, and the degree of bone density reduction. Pharmacotherapy should be adapted to the fracture risk. Osteoanabolic treatment is recommended with high priority if the patient is judged to have a very high risk of fracture (10% or more in the next three years). The further course and duration of treatment should be determined individually, depending on the evolution of the patient's clinical state.

Conclusion: Prerequisites for the optimal treatment of patients with osteoporosis include a correct diagnosis and interdisciplinary and interprofessional collaboration to determine and provide the proper treatment. 71% of persons with osteoporosis in Germany are still untreated, and this gap must be closed.

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临床实践指南：骨质疏松症的诊断与治疗。

背景：骨质疏松症是一种常见病，仅在德国就影响了大约600万人。骨质疏松性骨折会损害生活质量，并可能使独立生活变得不可能。骨质疏松症的诊断和治疗的建议是必不可少的有效护理这一大群患者。方法：为了全面更新德国骨质疏松症临床实践指南（循证指南，推荐临床实践），对相关出版物进行了全面、系统的检索，包括其他国家的指南。采用标准化（牛津）标准对检索到的文献进行评估，并根据PICO方案（“人群、干预、比较、结果”）回答临床相关的关键问题。结果：骨质疏松症临床危险因素评估是骨质疏松症诊断的基础，应在骨折后迅速进行。如果绝经后女性或50岁以上男性存在危险因素，建议使用双能x线骨密度仪（DXA）进行骨密度测定。进一步的诊断评估应根据临床症状、骨折状态和骨密度降低程度逐步进行。药物治疗应与骨折风险相适应。如果判断患者骨折风险非常高（未来三年骨折风险在10%或以上），建议优先进行骨合成代谢治疗。进一步的治疗过程和持续时间应根据患者临床状态的演变单独确定。结论：骨质疏松症患者获得最佳治疗的前提是正确的诊断和跨学科、跨专业的合作，以确定和提供适当的治疗。德国71%的骨质疏松症患者仍未得到治疗，这一差距必须缩小。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Deutsches Arzteblatt international 医学-医学：内科

CiteScore

4.10

自引率

5.20%

发文量

306

审稿时长

4-8 weeks

期刊介绍： Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.

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