骨质疏松症的诊断与管理:指南综述》。

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY Obstetrical & Gynecological Survey Pub Date : 2023-11-01 DOI:10.1097/OGX.0000000000001181
Elpiniki Rentzeperi, Stavroula Pegiou, Ioannis Tsakiridis, Ioannis Kalogiannidis, Anargyros Kourtis, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis
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引用次数: 0

摘要

重要性:骨质疏松症会导致发病率和死亡率上升,从而给全世界的医疗系统带来沉重的经济负担:本研究旨在回顾和比较最近出版的关于诊断和管理这种常见疾病的主要指南:证据采集:对澳大利亚皇家全科医师学院(RACGP)、欧洲骨质疏松症临床与经济学会-国际骨质疏松症基金会(ESCEO-IOF)、国家骨质疏松症指南小组(NOGG)、北美更年期学会(NAMS)、内分泌学会(ES)和美国妇产科医师学会(ACOG)最具影响力的指南进行了全面的比较审查:结果:所审查的指南在诊断骨质疏松症的定义、标准和检查方法上基本一致。它们还就骨质疏松症的风险因素和建议的生活方式调整(钙和维生素 D 摄入量、正常体重、减少饮酒和戒烟)达成了一致。然而,对于普通人群骨折风险评估的适应症以及骨矿物质密度评估的确切适应症还缺乏共识。转诊至骨科专家的情况仅限于复杂的骨质疏松症病例(NOGG、NAMS 和 ACOG)或无法获得充分治疗的情况(RACGP)。RACGP、NOGG 和 NAMS 均支持使用髋部保护器来降低骨折风险,但仅适用于住院护理环境中的高风险老年患者。所有审查过的指南都认可药理制剂(即双磷酸盐、地诺单抗、激素疗法和甲状旁腺激素类似物)的疗效。不过,关于药物治疗监测的建议有所不同,主要是在双膦酸盐方面。开始药物治疗后重复骨矿物质密度检测的建议间隔时间分别为 2 年(RACGP)、1-3 年(NAMS、ES 和 ACOG)或 3-5 年(ESCEO-IOF 和 NOGG)。所有指南都同意,骨转换标志物只能在骨专科中心用于治疗监测。最后,不同指南对治疗失败的定义也不尽相同:结论:骨质疏松症是一种令女性(主要是绝经后女性)苦恼的疾病。因此,为提高妇女的生活质量,为更具成本效益的诊断和管理技术制定一致的国际实践规程似乎至关重要。
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Diagnosis and Management of Osteoporosis: A Comprehensive Review of Guidelines.

Importance: Osteoporosis causes increased morbidity and mortality, and thus poses a significant economic burden to the health systems worldwide.

Objective: The aim of this study was to review and compare the most recently published major guidelines on diagnosis and management of this common medical entity.

Evidence acquisition: A thorough comparative review of the most influential guidelines from the RACGP (Royal Australian College of General Practitioners), the ESCEO-IOF (European Society for Clinical and Economic Aspects of Osteoporosis-International Osteoporosis Foundation), the NOGG (National Osteoporosis Guideline Group), the NAMS (North American Menopause Society), the ES (Endocrine Society), and the ACOG (American College of Obstetricians and Gynecologists) was conducted.

Results: The reviewed guidelines generally agree on the definition, the criteria, and investigations used to diagnose osteoporosis. They also concur regarding the risk factors for osteoporosis and the suggested lifestyle modifications (calcium and vitamin D intake, normal body weight, reduction of alcohol consumption, and smoking cessation). However, there is lack of consensus on indications for fracture risk assessment in the general population and the exact indications for bone mineral density assessment. Referral to a bone specialist is reserved for complex cases of osteoporosis (NOGG, NAMS, and ACOG) or in case of inadequate access to care (RACGP). The use of hip protectors to reduce the risk of fractures is supported by RACGP, NOGG, and NAMS, solely for high-risk elderly patients in residential care settings. All guidelines reviewed recognize the efficacy of the pharmacologic agents (ie, bisphosphonates, denosumab, hormone therapy, and parathyroid hormone analogs). Nonetheless, recommendations regarding monitoring of pharmacotherapy differ, primarily in the case of bisphosphonates. The proposed intervals of repeat bone mineral density testing after initiation of drug therapy are set at 2 years (RACGP), 1-3 years (NAMS, ES, and ACOG), or 3-5 years (ESCEO-IOF and NOGG). All guidelines agree upon the restricted use of bone turnover markers only in bone specialist centers for treatment monitoring purposes. Finally, the definition of treatment failure varies among the reviewed guidelines.

Conclusions: Osteoporosis is a distressing condition for women, mainly those of postmenopausal age. Thus, it seems of paramount importance to develop consistent international practice protocols for more cost-effective diagnostic and management techniques, in order to improve women's quality of life.

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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
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