Romme Elisabeth A P M, Geusens Piet, Lems Willem F, Rutten Erica P A, Smeenk Frank W J M, van den Bergh Joop P W, van Hal Peter ThW, Wouters Emiel F M
Respir Res. 2015 Mar 7;16(1):32. doi: 10.1186/s12931-015-0192-8.
Although osteoporosis and its related fractures are common in patients with COPD, patients at high risk of fracture are poorly identified, and consequently, undertreated. Since there are no fracture prevention guidelines available that focus on COPD patients, we developed a clinical approach to improve the identification and treatment of COPD patients at high risk of fracture. We organised a round-table discussion with 8 clinical experts in the field of COPD and fracture prevention in the Netherlands in December 2013. The clinical experts presented a review of the literature on COPD, osteoporosis and fracture prevention. Based on the Dutch fracture prevention guideline, they developed a 5-step clinical approach for fracture prevention in COPD. Thereby, they took into account both classical risk factors for fracture (low body mass index, older age, personal and family history of fracture, immobility, smoking, alcohol intake, use of glucocorticoids and increased fall risk) and COPD-specific risk factors for fracture (severe airflow obstruction, pulmonary exacerbations and oxygen therapy). Severe COPD (defined as postbronchodilator FEV1 < 50% predicted) was added as COPD-specific risk factor to the list of classical risk factors for fracture. The 5-step clinical approach starts with case finding using clinical risk factors, followed by risk evaluation (dual energy X-ray absorptiometry and imaging of the spine), differential diagnosis, treatment and follow-up. This systematic clinical approach, which is evidence-based and easy-to-use in daily practice by pulmonologists, should contribute to optimise fracture prevention in COPD patients at high risk of fracture.
虽然骨质疏松症及其相关骨折在慢性阻塞性肺疾病（COPD）患者中很常见，但骨折高危患者却很少得到识别，因此治疗不足。由于目前尚无专门针对COPD患者的骨折预防指南，我们制定了一种临床方法，以改善对COPD骨折高危患者的识别和治疗。2013年12月，我们在荷兰组织了一次由8位COPD和骨折预防领域临床专家参与的圆桌讨论。临床专家们对COPD、骨质疏松症和骨折预防的文献进行了综述。基于荷兰骨折预防指南，他们制定了一种针对COPD患者骨折预防的五步临床方法。在制定过程中，他们既考虑了骨折的经典危险因素（低体重指数、高龄、个人和家族骨折史、行动不便、吸烟、饮酒、使用糖皮质激素以及跌倒风险增加），也考虑了COPD特有的骨折危险因素（严重气流受限、肺部急性加重和氧疗）。重度COPD（定义为支气管扩张剂使用后第一秒用力呼气容积（FEV1）<预测值的50%）被作为COPD特有的危险因素添加到骨折经典危险因素列表中。五步临床方法始于利用临床危险因素进行病例筛查，随后是风险评估（双能X线吸收法和脊柱成像）、鉴别诊断、治疗及随访。这种基于证据且易于肺科医生在日常实践中使用的系统临床方法，应有助于优化对骨折高危COPD患者的骨折预防。
