Abstract:
An evidence-based clinical guideline for the diagnosis and management of Paget\'s disease of bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget\'s Association (UK). A systematic review of diagnostic tests and pharmacological and nonpharmacological treatment options was conducted that sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made, but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important: 1) Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of metabolically active disease in patients with PDB. 2) Serum total alkaline phosphatase (ALP) is recommended as a first-line biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB. 3) Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. 4) Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalizing total ALP in PDB. 5) Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone Research Society (UK), and the British Geriatric Society. The GDG noted that there had been a lack of research on patient-focused clinical outcomes in PDB and identified several areas where further research was needed. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
摘要:
使用GRADE方法开发了诊断和管理Paget骨病(PDB)的循证临床指南,由佩吉特协会(英国)领导的指导方针发展小组(GDG)领导。对诊断测试以及药理学和非药理学治疗方案进行了系统评价,旨在解决临床相关的几个关键问题。提出了12项建议和5项有条件建议,但是没有足够的证据来解决提出的八个问题。以下建议被认为是最重要的:1)放射性核素骨扫描,除了有针对性的射线照片,建议作为一种方法,充分和准确地定义代谢活跃疾病的PDB患者的程度。2)推荐血清总碱性磷酸酶(ALP)作为一线生化筛查试验,结合肝功能检查,筛查代谢活性PDB的存在。3)双膦酸盐被推荐用于治疗与PDB相关的骨痛。唑来膦酸被推荐作为双膦酸盐最有可能给出有利的疼痛反应。4)建议采用旨在改善症状的治疗,而不是旨在使PDB中的总ALP正常化的治疗目标策略。5)对于患有骨关节炎的PDB患者,建议进行全髋关节或膝关节置换,其中药物治疗不足。没有足够的信息来推荐一种类型的手术方法。该准则得到了欧洲钙化组织协会的认可,国际骨质疏松基金会,美国骨与矿物研究学会,骨研究协会(英国),和英国老年病学会。GDG指出,PDB中缺乏以患者为中心的临床结果的研究,并确定了需要进一步研究的几个领域。©2019作者Wiley期刊公司出版的骨与矿物研究杂志。