Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
Rheumatol Int. 2018 Dec;38(12):2193-2208. doi: 10.1007/s00296-018-4181-3. Epub 2018 Oct 26.
We examined international osteoporosis guidelines to determine the tools used to assess fracture risk, the classification of fracture risk presented, and the recommendations based on fracture risk status. We conducted a document analysis of guidelines from the International Osteoporosis Foundation (IOF) website retrieved as of May 10, 2018, focusing on guidelines written in English only. Two reviewers independently reviewed each document and the following data were extracted: (1) fracture risk tool(s) endorsed; (2) classification system used to describe fracture risk status (e.g., low, moderate, high); and (3) recommendations based on risk status (e.g., pharmacological treatment). Two additional reviewers verified all data extraction. A total of 112 guidelines were listed on the IOF website, of which 94 were located either through the provided link or through a PubMed search. Of 70 guidelines written in English, 63 guidelines discussed the concept of fracture risk of which, 39 endorsed FRAX. Twenty-eight guidelines defined fracture risk categories or thresholds which determined recommendations. In total, 26 provided a risk category or threshold which constituted an indication for pharmacotherapy. Twelve guidelines reported a moderate, medium, or intermediate risk category which was associated with variable recommendations for testing and treatment. Despite the generally accepted international shift to fracture risk as a basis for treatment decisions, the majority of guidelines in English did not provide treatment recommendations based on fracture risk status. In guidelines with recommendations based on fracture risk status, thresholds and recommendations varied making international comparisons of treatment difficult.
我们检查了国际骨质疏松症指南，以确定用于评估骨折风险的工具、呈现的骨折风险分类以及基于骨折风险状况的建议。我们对国际骨质疏松基金会（IOF）网站上截至 2018 年 5 月 10 日检索到的英文指南进行了文件分析。两位评审员独立审查了每份文件，并提取了以下数据：（1）认可的骨折风险工具；（2）用于描述骨折风险状况的分类系统（例如，低、中、高）；（3）基于风险状况的建议（例如，药物治疗）。另外两位评审员验证了所有的数据提取。IOF 网站上共列出了 112 条指南，其中 94 条通过提供的链接或通过 PubMed 搜索找到。在 70 条英文指南中，有 63 条讨论了骨折风险的概念，其中 39 条认可了 FRAX。28 条指南定义了骨折风险类别或阈值，这些类别或阈值决定了建议。共有 26 条指南提供了一个风险类别或阈值，这构成了药物治疗的指征。12 条指南报告了中度、中等或中间风险类别，这与测试和治疗的可变建议相关。尽管国际上普遍倾向于将骨折风险作为治疗决策的基础，但大多数英文指南并未根据骨折风险状况提供治疗建议。在基于骨折风险状况的建议的指南中，阈值和建议存在差异，使得治疗的国际比较变得困难。
