Lorenc Roman, Głuszko Piotr, Franek Edward, Jabłoński Mirosław, Jaworski Maciej, Kalinka-Warzocha Ewa, Karczmarewicz Elzbieta, Kostka Tomasz, Księzopolska-Orłowska Krystyna, Marcinowska-Suchowierska Ewa, Misiorowski Waldemar, Więcek Andrzej
Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation. Warsaw, Poland.
Endokrynol Pol. 2017;68(5):604-609. doi: 10.5603/EP.2017.0062.
In the rapidly ageing society in Poland, osteoporosis is a growing epidemiological problem, and osteoporosis-related fractures are a cause of chronic disability and considerable increase of death risk. It turns out that 80 to 90% of patients suffering from osteoporosis, including osteoporosis accompanied by fractures, do not receive adequate pharmacotherapy. In this paper, a Guideline Working Group of experts from the Multidisciplinary Osteoporosis Forum update the existing Polish guidelines concerning the diagnosis and management of osteoporosis (last revised in 2013), taking account of the latest literature, availability and reimbursement of drugs, and current health care organisation. In the revised guidelines, we still postulate that tasks are divided between primary care doctors (stage I) and specialists in osteoporosis management (stage II). We emphasise the necessity of early initiation of pharmacotherapy and rehabilitation in all patients with low-energy fractures. We recommend that the 10-year fracture risk should be estimated in all patients (including those without fractures) who are over 50 years of age, and that the Polish threshold for therapeutic intervention should be adopted: ≥ 10% for FRAX PL calculator. We add strategies of drug choice and therapy monitoring with imaging, and densitometric and biochemical diagnostics. We define basic guidelines concerning prevention of falls, rehabilitation, and dietary procedures, and elimination of environmental and other fracture risk factors. We point to two vital elements for improving osteoporosis management: 1) strategy of supervision over fractures management - Fracture Liaison Service (FLS), and, optimally, 2) strategies of short-term monitoring of the therapeutic efficacy with the use of biochemical markers.
在波兰快速老龄化的社会中，骨质疏松症是一个日益严重的流行病学问题，与骨质疏松症相关的骨折是导致慢性残疾和死亡风险显著增加的原因。事实证明，80%至90%的骨质疏松症患者，包括伴有骨折的骨质疏松症患者，没有接受足够的药物治疗。在本文中，多学科骨质疏松症论坛的专家指南工作组更新了现有的波兰关于骨质疏松症诊断和管理的指南（上次修订于2013年），同时考虑了最新文献、药物的可获得性和报销情况以及当前的医疗保健组织。在修订后的指南中，我们仍然主张任务由初级保健医生（第一阶段）和骨质疏松症管理专家（第二阶段）分担。我们强调所有低能量骨折患者尽早开始药物治疗和康复的必要性。我们建议对所有50岁以上的患者（包括无骨折患者）估计其10年骨折风险，并采用波兰的治疗干预阈值：FRAX PL计算器≥10%。我们增加了药物选择策略以及通过影像学、骨密度和生化诊断进行治疗监测的内容。我们定义了关于预防跌倒、康复、饮食程序以及消除环境和其他骨折风险因素的基本指南。我们指出改善骨质疏松症管理的两个关键要素：1）骨折管理监督策略——骨折联络服务（FLS），以及最理想的2）使用生化标志物进行治疗效果短期监测的策略。
