背景:尽管合成糖皮质激素(GC)通常用于治疗自身免疫性疾病和其他疾病,GC诱导的骨质疏松(GIOP)占不良反应的25%,导致30-50%的患者骨折,并显著降低他们的生活质量。2014年,日本骨与矿物质研究学会(JSBMR)发布了经修订的类固醇引起的骨质疏松症的管理和治疗指南,根据风险因素的得分提供治疗标准,包括以前的骨折,年龄,GC剂量,和骨密度,对于接受GC治疗或计划接受GC治疗≥3个月的≥18岁患者。
方法:JSBMR的GIOP管理和治疗指南修订委员会根据GRADE方法准备了17个临床问题(CQs),并使用Delphi方法通过系统评价和共识会议修订了GIOP的管理和治疗指南。
结果:双膦酸盐(口服和注射制剂),抗RANKL抗体特立帕肽,eldecalcitol,对于已经接受或计划接受GC治疗且危险因素评分≥3分的患者,推荐使用或选择性雌激素受体调节剂.建议在GC治疗的同时开始使用骨质疏松症药物,以预防老年患者的脆性骨折。
结论:2023年GIOP的管理和治疗指南是通过使用德尔菲法进行系统综述和共识会议制定的。
BACKGROUND: Although synthetic glucocorticoids (GCs) are commonly used to treat autoimmune and other diseases, GC induced osteoporosis (GIOP) which accounts for 25% of the adverse reactions, causes fractures in 30-50% of patients, and markedly decreases their quality of life. In 2014, the Japanese Society for Bone and Mineral Research (JSBMR) published the revised
guidelines for the management and treatment of steroid-induced osteoporosis, providing the treatment criteria based on scores of risk factors, including previous fractures, age, GC doses, and bone mineral density, for patients aged ≥18 years who are receiving GC therapy or scheduled to receive GC therapy for ≥3 months.
METHODS: The Committee on the revision of the
guidelines for the management and treatment of GIOP of the JSBMR prepared 17 clinical questions (CQs) according to the GRADE approach and revised the guidelines for the management and treatment of GIOP through systematic reviews and
consensus conferences using the Delphi method.
RESULTS: Bisphosphonates (oral and injectable formulations), anti-RANKL antibody teriparatide, eldecalcitol, or selective estrogen receptor modulators are recommended for patients who has received or scheduled for GC therapy with risk factor scores of ≥3. It is recommended that osteoporosis medication is started concomitantly with the GC therapy for the prevention of fragility fractures in elderly patients.
CONCLUSIONS: The 2023
guidelines for the management and treatment of GIOP was developed through systematic reviews and
consensus conferences using the Delphi method.