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1、Management of osteoporosis and theprevention of fragility fractures,骨质疏松的管理与脆性骨折的预防,Scottish Intercollegiate Guidelines Network苏格兰校际指南网,LEVELS OF EVIDENCE,1+ High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1+ Well conducted meta-analyses, systematic revie
2、ws, or RCTs with a low risk of bias 1 - Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2+High quality systematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the rela
3、tionship is causal 2+ Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal 2 - Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
4、3 Non-analytic studies, eg case reports, case series 4 Expert opinion,The need for a guideline,In 2012, fractures occurred in 19.8 out of 1,000 women and 8.4 out of 1,000 men over the age of 50 in Scotland. The majority of fractures occur in people over the age of 65 and a large proportion of these
5、patients have osteoporosis. Fractures are an important cause of morbidity , and patients who suffer hip fractures 髋部骨折and vertebral fractures 椎体骨折have a decreased life expectancy compared with population-based controls.,2 Key recommendations,2.2quantifying the risk of fracture Fracture-risk assessme
6、nt should be carried out, preferably using Q Fracture, prior to DXA in patients with clinical risk factors for osteoporosis and in whom antiosteoporosis treatment is being considered. Measurement of bone mineral density by DXA at the spine and hip should be carried out following fracture-risk assess
7、ment in patients in whom antiosteoporosis treatment is being considered.,2 Key recommendations,2.3 management of osteoporosis in postmenopausal women Repeat BMD measurements by DXA after an interval of three years may be considered to assess response to treatment in postmenopausal women on alendroni
8、c acid阿仑膦酸, ibandronic acid伊班膦酸, zolendronic acid 唑来磷酸 or denosumab狄诺塞麦therapy.,2 Key recommendations,2.4 Systems of care Patients over the age of 50 who have experienced a fragility fracture脆性骨折should be managed within a formal integrated system of care that incorporates a fracture liaison service.
9、 Management of osteoporosis and the prevention of fragility fractures guide.,3 Risk factors,risk in the context of osteoporosis 3.1.1Descriptors of risk 描述性分析 相对、绝对 3.1.2 Modifiable risk 可变风险 Modifiable risk factors are those that can be treated or modified by an appropriate intervention. alcohol in
10、take, diet, smoking and BMD might be considered modifiable, whereas others such as age, gender and ethnicity are non-modifiable. While risk factors have been categorised as modifiable or non-modifiable in the following section, it is recognised that both characteristics may apply to some risk factor
11、s.,Risk factors,3.1.3 Single and multiple risk factors These measurements include assessment of bone density, for example, with DXA, measurement of bone quality, for example, with ultrasound densitometry, or measurement of bone turnover, for example, using biochemical markers.,这些测量包括骨密度，如DXA，骨质量，超声测
12、量骨密度，或者生化标记。,3.2non-modifiable risk factors,3.2.1 Age ：People below the age of 50 are likely to be at low risk of fracture in the absence of other risk factors. 3.2.2Gender：Women are at increased risk of osteoporotic (distal radius, hip or vertebral) and hip fractures compared with men. the overall
13、incidence of osteoporotic .fracture in women was 3.08 per 1,000 person-years (95% confidence interval (CI) 3.04 to 3.12) and 0.99 (95% CI 0.96 to 1.01) per 1,000 person-years in men. Hip fracture incidence was lower in both women and men at 1.15 (95% CI 1.13 to 1.17) and 0.38 (95% CI 0.36 to 0.39) p
14、er 1,000 person-years respectively.,non-modifiable risk factors,3.2.3 Ethnicity Caucasian白人 men and women are at increased risk of fragility fractures at all sites compared with other ethnic groups. Black Caribbean加勒比 women are at the lowest risk of any osteoporotic fracture. In men, Bangladeshi men
15、 are at lowest risk for any osteoporotic. At the age of 6569, the hip fracture rates for men and women were less than half of, but the vertebral fracture rate was higher in Asian women, resulting in a high vertebral-to-hip fracture ratio.,3.2.4 previous fracture,People with a history of fragility fr
16、actures over the age of 50 should be offered DXA scanning to evaluate the need for antiosteoporosis therapy. 50岁以上的有脆性骨折史的人应给予DXA扫描来评估抗骨质疏松治疗的需要。,3.2.5 Family history,People with a parental history of osteoporosis, particularly those over the age of 50, should be considered for fracture-risk assessment.,3.2.6Reproductive factors生殖因素,Women over the age of 50 with a history of previously untreated early menopause早期绝经should be considered for fracture-risk assessment, particularly in the presence
