2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
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DOI：
10.1002/art.40137
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发表时间：
2017-08-01
影响因子：
13.3
通讯作者：
McAlindon, Timothy
中科院分区：
文献类型：
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作者：
Buckley, Lenore;Guyatt, Gordon;McAlindon, Timothy
Objective.为预防和治疗糖皮质激素性骨质疏松症（GIOP）提供建议。我们进行了一项系统性综述，以综合GIOP预防和治疗方案的益处和危害的证据。建议评估、发展和评价的分级方法被用来评定证据的质量。我们使用了一个小组共识过程来确定最终的建议，并对其强度进行评级。该指南阐述了开始或继续长期（>= 3个月）糖皮质激素（GC）治疗的患者的初始评估和再评估，以及生活方式改变和钙、维生素D、双膦酸盐、雷洛昔芬、特立哌酮和地舒单抗治疗在接受长期GC治疗的普通成人人群以及长期GC使用者的特殊人群中的相对益处和危害。由于关于GC使用者干预的获益和危害的证据有限，本指南中的大多数建议都是有条件的（获益和危害之间的不确定平衡）。建议包括对骨折风险较低的成年人仅使用钙和维生素D进行治疗，使用钙和维生素D加上额外的骨质疏松症药物进行治疗（首选口服双膦酸盐）在中度至高度骨折风险的成人中，继续钙加维生素D，但在口服双膦酸盐治疗不合适的成人中，从口服双膦酸盐转换为另一种抗骨折药物，在完成计划的口服双膦酸盐方案但继续接受GC治疗的成人中，继续口服双膦酸盐治疗或改用另一种抗骨折药物。对特殊人群，包括儿童、器官移植患者、有生育能力的妇女和接受高剂量GC治疗的患者也提出了建议。本指南为临床医生和患者做出治疗决策提供了指导。临床医生和患者应使用共同的决策过程，考虑患者的价值观，偏好和合并症。这些建议不应用于限制或拒绝获得治疗。
Objective. To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP).Methods. We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (>= 3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users.Results. Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made.Conclusion. This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.