加拿大骨质疏松症2023年临床实践指南通过完善对属于2010年指南“中等风险”类别的人群的治疗指导,增加了推荐或建议用于抗骨质疏松症药物治疗的人数。
目的:2023年,加拿大骨质疏松在考虑骨折史的基础上更新了其2010年临床实践指南,10年严重骨质疏松性骨折(MOF)风险,和BMDT评分与年龄相关。2023年指南取消了风险类别,包括未提供明确治疗指导的中等风险组.进行当前研究是为了了解从2010年风险类别到2023年治疗指导的转变的含义。
方法:研究人群包括1996年1月至2018年3月接受基线DXA检测的79,654名年龄≥50岁的个体。根据2010年和2023年指南建议,每个人都被分配到相互排斥的类别。治疗资格,比较了10年预测和10年观察到的MOF风险。
结果:根据2023年指南进行的治疗重新分类仅影响了2010年中度风险组中的33.8%的个人,13.0%的人没有接受治疗,14.4%建议治疗,和6.4%建议治疗。在平均7.2年的随访中,6364人(8.0%)经历了一次或多次MOF事件。在研究人群中观察到的MOF的10年累积发生率为10.5%,而预测的10.7%(观察到的平均校准比0.98,95%CI0.96-1.00)。从2010年中度风险重新分类到2023年推荐治疗的个体的MOF风险高于分配到2023年建议治疗或不治疗的2010年中度风险组的个体。但风险低于2010年高危人群。
结论:加拿大骨质疏松症2023年临床实践指南影响2010年中度风险类别中的个体,增加推荐或建议抗骨质疏松药物治疗的人数。增加治疗可以减轻骨质疏松性骨折的人群负担,尽管目前符合治疗条件的中危个体预测和观察到的骨折风险低于2010年指南推荐的高危个体.
Osteoporosis Canada 2023 clinical practice
guidelines increase the number of individuals recommended or suggested for anti-osteoporosis pharmacotherapy by refining treatment guidance for those who fell within the 2010
guidelines\' moderate-risk category.
OBJECTIVE: In 2023, Osteoporosis Canada updated its 2010 clinical practice
guidelines based upon consideration of fracture history, 10-year major osteoporotic fracture (MOF) risk, and BMD T-score in conjunction with age. The 2023
guidelines eliminated risk categories, including the moderate-risk group that did not provide clear treatment guidance. The current study was performed to appreciate the implications of the shift from 2010 risk categories to 2023 treatment guidance.
METHODS: The study population consisted of 79,654 individuals age ≥ 50 years undergoing baseline DXA testing from January 1996 to March 2018. Each individual was assigned to mutually exclusive categories based on 2010 and 2023
guideline recommendations. Treatment qualification, 10-year predicted and 10-year observed MOF risk were compared.
RESULTS: Treatment reclassification under the 2023 guidelines only affected 33.8% of individuals in the 2010 moderate-risk group, with 13.0% assigned to no treatment, 14.4% to suggest treatment, and 6.4% to recommend treatment. During the mean follow-up of 7.2 years, 6364 (8.0%) individuals experienced one or more incidents of MOF. The observed 10-year cumulative incidence of MOF in the study population was 10.5% versus the predicted 10.7% (observed to predicted mean calibration ratio 0.98, 95% CI 0.96-1.00). Individuals reclassified from 2010 moderate risk to 2023 recommend treatment were at greater MOF risk than those in the 2010 moderate-risk group assigned to 2023 suggest treatment or no treatment, but at lower risk than those in the 2010 high-risk group.
CONCLUSIONS: Osteoporosis Canada 2023 clinical practice guidelines affect individuals within the 2010 moderate-risk category, increasing the number for whom anti-osteoporosis pharmacotherapy is recommended or suggested. Increased treatment could reduce the population burden of osteoporotic fractures, though moderate-risk individuals now qualifying for treatment have a lower predicted and observed fracture risk than high-risk individuals recommended for treatment under the 2010 guidelines.