我们对来自五个欧盟国家的10个国家指南进行了审查,以确定骨质疏松症患者管理建议的相似性或差异性。我们发现主要建议大致一致;然而,有显著的差异,主要归因于针对特定国家的风险评估和偿还条件的方法。
背景:骨折风险的分类对于告知绝经后骨质疏松症的治疗决策至关重要。这次审查的目的是总结来自五个欧洲国家的10个国家指南,重点是确定骨质疏松症患者管理建议的相似性或差异性。
方法:我们总结了欧洲骨质疏松症临床和经济方面的学会,骨关节炎和肌肉骨骼疾病-国际骨质疏松基金会指南和来自法国的审查指南,德国,意大利,西班牙和英国。
结果:不同指南的风险评估方法不同。在法国,西班牙,风险评估基于DXA扫描和先前骨折的存在,而英国,德国和意大利指南建议使用经过验证的风险工具。这些差异导致了非常高风险和高风险患者的不同定义。指南一致推荐抗吸收和合成代谢药物作为治疗骨质疏松症的药理学选择,建议序贯治疗。人们一致认为,骨折风险高或非常高或患有严重骨质疏松症的患者应首先接受合成代谢药,其次是抗吸收药物。在对患者进行抗骨质疏松治疗的随访建议中发现了差异。每个国家的偿还条件是确定的关键差异。
结论:不同欧洲指南的骨折风险评估标准不同,这可能会影响治疗和合成代谢药物的使用。欧盟指南之间的协调可能有助于确定有资格接受治疗的患者并影响治疗。然而,特定国家的报销和处方流程可能对在整个欧洲实现一致的方法构成挑战。
We conducted a review of 10 national
guidelines from five EU countries to identify similarities or differences in recommendations for the management of patients with osteoporosis. We found general alignment of key recommendations; however, there are notable differences, largely attributed to country-specific approaches to risk assessment and reimbursement conditions.
BACKGROUND: The classification of fracture risk is critical for informing treatment decisions for post-menopausal osteoporosis. The aim of this review was to summarise 10 national
guidelines from five European countries, with a focus on identifying similarities or differences in recommendations for the management of patients with osteoporosis.
METHODS: We summarised the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Disease-International Osteoporosis Foundation guidelines and reviewed
guidelines from France, Germany, Italy, Spain and the UK.
RESULTS: The approach to risk assessment differed across the
guidelines. In France, and Spain, risk assessment was based on DXA scans and presence of prior fractures, whereas UK, German and Italian guidelines recommended use of a validated risk tool. These differences led to distinct definitions of very high and high-risk patients.
Guidelines aligned in recommending antiresorptive and anabolic agents as pharmacologic options for the management of osteoporosis, with sequential treatment recommended. There was agreement that patients at high or very high risk of fracture or with severe osteoporosis should receive anabolic agents first, followed by antiresorptive drugs. Variations were identified in recommendations for follow up of patients on anti-osteoporosis therapies. Reimbursement conditions in each country were a key difference identified.
CONCLUSIONS: Criteria for risk assessment of fractures differ across European guidelines which may impact treatment and access to anabolic agents. Harmonisation across EU guidelines may help identify patients eligible for treatment and impact treatment uptake. However, country-specific reimbursement and prescribing processes may present a challenge to achieving a consistent approach across Europe.