2015SIGN骨质疏松的管理与脆性骨折的预防.

Managementofosteoporosisandthepreventionoffragilityfractures骨质疏松的管理与脆性骨折的预防ScottishIntercollegiateGuidelinesNetwork苏格兰校际指南网LEVELSOFEVIDENCE•1++Highqualitymeta-analyses,systematicreviewsofRCTs,orRCTswithaverylowriskofbias•1+Wellconductedmeta-analyses,systematicreviews,orRCTswithalowriskofbias•1-Meta-analyses,systematicreviews,orRCTswithahighriskofbias•2++HighqualitysystematicreviewsofcasecontrolorcohortstudiesHighqualitycasecontrolorcohortstudieswithaverylowriskofconfoundingorbiasandahighprobabilitythattherelationshipiscausal•2+Wellconductedcasecontrolorcohortstudieswithalowriskofconfoundingorbiasandamoderateprobabilitythattherelationshipiscausal•2-Casecontrolorcohortstudieswithahighriskofconfoundingorbiasandasignificantriskthattherelationshipisnotcausal•3Non-analyticstudies,egcasereports,caseseries•4ExpertopinionTheneedforaguidelineIn2012,fracturesoccurredin19.8outof1,000womenand8.4outof1,000menovertheageof50inScotland.Themajorityoffracturesoccurinpeopleovertheageof65andalargeproportionofthesepatientshaveosteoporosis.Fracturesareanimportantcauseofmorbidity,andpatientswhosufferhipfractures髋部骨折andvertebralfractures椎体骨折haveadecreasedlifeexpectancycomparedwithpopulation-basedcontrols.2Keyrecommendations•2.1riskfactors–Peoplewithahistoryoffragilityfracturesovertheageof50shouldbeofferedDXAscanningtoevaluatetheneedforantiosteoporosistherapy.2Keyrecommendations•2.2quantifyingtheriskoffracture–Fracture-riskassessmentshouldbecarriedout,preferablyusingQFracture,priortoDXAinpatientswithclinicalriskfactorsforosteoporosisandinwhomantiosteoporosistreatmentisbeingconsidered.–MeasurementofbonemineraldensitybyDXAatthespineandhipshouldbecarriedoutfollowingfracture-riskassessmentinpatientsinwhomantiosteoporosistreatmentisbeingconsidered.2Keyrecommendations•2.3managementofosteoporosisinpostmenopausalwomen–RepeatBMDmeasurementsbyDXAafteranintervalofthreeyearsmaybeconsideredtoassessresponsetotreatmentinpostmenopausalwomenonalendronicacid阿仑膦酸,ibandronicacid伊班膦酸,zolendronicacid唑来磷酸ordenosumab狄诺塞麦therapy.2Keyrecommendations•2.4Systemsofcare–Patientsovertheageof50whohaveexperiencedafragilityfracture脆性骨折shouldbemanagedwithinaformalintegratedsystemofcarethatincorporatesafractureliaisonservice.Managementofosteoporosisandthepreventionoffragilityfracturesguide.3Riskfactorsriskinthecontextofosteoporosis•3.1.1Descriptorsofrisk描述性分析相对、绝对•3.1.2Modifiablerisk可变风险Modifiableriskfactorsarethosethatcanbetreatedormodifiedbyanappropriateintervention.alcoholintake,diet,smokingandBMDmightbeconsideredmodifiable,whereasotherssuchasage,genderandethnicityarenon-modifiable.Whileriskfactorshavebeencategorisedasmodifiableornon-modifiableinthefollowingsection,itisrecognisedthatbothcharacteristicsmayapplytosomeriskfactors.Riskfactors•3.1.3Singleandmultipleriskfactors–Thesemeasurementsincludeassessmentofbonedensity,forexample,withDXA,measurementofbonequality,forexample,withultrasounddensitometry,ormeasurementofboneturnover,forexample,usingbiochemicalmarkers.这些测量包括骨密度，如DXA，骨质量，超声测量骨密度，或者生化标记。3.2non-modifiableriskfactors•3.2.1Age：Peoplebelowtheageof50arelikelytobeatlowriskoffractureintheabsenceofotherriskfactors.•3.2.2Gender：Womenareatincreasedriskofosteoporotic(distalradius,hiporvertebral)andhipfracturescomparedwithmen.theoverallincidenceofosteoporotic.fractureinwomenwas3.08per1,000person-years(95%confidenceinterval(CI)3.04to3.12)and0.99(95%CI0.96to1.01)per1,000person-yearsinmen.Hipfractureincidencewaslowerinbothwomenandmenat1.15(95%CI1.13to1.17)and0.38(95%CI0.36to0.39)per1,000person-yearsrespectively.non-modifiableriskfactors•3.2.3Ethnicity–Caucasian白人menandwomenareatincreasedriskoffragilityfracturesatallsitescomparedwithotherethnicgroups.BlackCaribbean加勒比womenareatthelowestriskofanyosteoporoticfracture.Inmen,Bangladeshimenareatlowestriskforanyosteoporotic.–Attheageof65–69,thehipfractureratesformenandwomenwerelessthanhalfof,butthevertebralfractureratewashigherinAsianwomen,resultinginahighvertebral-to-hipfractureratio.3.2.4previousfracture•Peoplewithahistoryoffragilityfracturesovertheageof50shouldbeofferedDXAscanningtoevaluatetheneedforantiosteoporosistherapy.•50岁以上的有脆性骨折史的人应给予DXA扫描来评估抗骨质疏松治疗的需要。3.2.5Familyhistory•Peoplewithaparentalhistoryofosteoporosis,particularlythoseovertheageof50,shouldbeconsideredforfracture-riskassessment.3.2.6Reproductivefactors生殖因素•Womenovertheageof50withahistoryofpreviouslyuntreatedearlymenopause早期绝经shouldbeconsideredforfracture-riskassessment,particularlyinthepresenceofotherriskfactors.33.modifiableriskfactors可变风险•3.3.1bonemineraldensity–WomenandmenwithlowBMDonDXAscanningshouldundergofurtherfracture-riskassessmenttoevaluatetheneedforantiosteoporosistherapy.–女性和男性低BMDDXA扫描应该接受进一步的骨折风险评估抗骨质疏松治疗的需要。.3modifiableriskfactors可变风险•3.3.2Alcoholintake–Peopleovertheageof50whoconsumemorethan3.5unitsofalcoholperdayshouldbeconsideredforfracture-riskassessment.–Peoplewhoconsumemorethan3.5unitsofalcoholperdayshouldbeadvisedtoreducetheiralcoholintaketonationallyrecommendedlevels(21units/weekinmen,14unitsperweekinwomen).modifiableriskfactors可变风险•3.3