Duque Gustavo, Mallet Louise, Roberts Ayanna, Gingrass Serge, Kremer Richard, Sainte-Marie Louis-Georges, Kiel Douglas P
Division of Geriatric Medicine, McGill University-Jewish General Hospital, 3755 Côte Sainte Catherine, Montreal, Quebec, Canada.
J Am Med Dir Assoc. 2006 Sep;7(7):435-41. doi: 10.1016/j.jamda.2006.05.006. Epub 2006 Jul 7.
Patients in long-term care institutions (LTCI) are especially at risk for osteoporotic fractures owing to their lack of mobility, poor nutrition, and limited sun exposure. Previous reports have shown that osteoporosis is underdiagnosed and undertreated in LTCI despite the high incidence of osteoporotic fractures in these settings. This document has been developed to assist clinicians practicing in LTCI with the diagnosis and treatment of osteoporosis in their institutionalized patients. These proceedings offer an overview of the particular characteristics of patients at LTCI. Management strategies include both nonpharmacological and pharmacological interventions for the prevention and treatment of osteoporotic fractures in very frail older subjects.
This guide is an edited review of presentations and discussions held by specialists in osteoporosis in the elderly together with physicians and pharmacists practicing in LTCI in the province of Quebec. This symposium was held in Saint-Hyacinthe, Quebec on November 5, 2004.
The value of a given diagnostic test or treatment option was determined based on the clinical experiences and opinions of the participants and a review of the literature from an evidence-based perspective.
All patients located at LTCI are at potential risk for osteoporotic fractures. Global interventions should include vitamin D, calcium, and a comprehensive exercise program. In patients who are at high risk for osteoporotic fractures or with previous fractures, pharmacological treatment should be started.
These recommendations were approved during the final plenary of the symposium. All the prevailing opinions were summarized and included in this article.
长期护理机构（LTCI）中的患者尤其容易发生骨质疏松性骨折，原因是他们行动不便、营养状况差且日照有限。先前的报告显示，尽管LTCI中骨质疏松性骨折的发生率很高，但骨质疏松症在这些机构中仍未得到充分诊断和治疗。本文件旨在协助在LTCI工作的临床医生对其机构内患者的骨质疏松症进行诊断和治疗。这些程序概述了LTCI患者的特殊特征。管理策略包括针对非常虚弱的老年受试者预防和治疗骨质疏松性骨折的非药物和药物干预措施。
本指南是对老年骨质疏松症专家以及魁北克省LTCI的医生和药剂师所做的报告和讨论进行编辑后的综述。本次研讨会于2004年11月5日在魁北克省圣亚森特举行。
根据参与者的临床经验和意见以及从循证角度对文献的综述，确定了特定诊断测试或治疗方案的价值。
LTCI中的所有患者都有发生骨质疏松性骨折的潜在风险。全面的干预措施应包括维生素D、钙和综合锻炼计划。对于骨质疏松性骨折高危患者或既往有骨折的患者，应开始药物治疗。
这些建议在研讨会的最后全体会议上获得批准。所有普遍的意见都进行了总结并纳入本文。
