Park So Young, Gong Hyun Sik, Kim Kyoung Min, Kim Dam, Kim Ha Young, Jeon Chan Hong, Ju Ji Hyeon, Lee Shin-Seok, Park Dong-Ah, Sung Yoon-Kyoung, Kim Sang Wan
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
J Bone Metab. 2018 Nov;25(4):195-211. doi: 10.11005/jbm.2018.25.4.195. Epub 2018 Nov 30.
To develop guidelines and recommendations to prevent and treat glucocorticoid (GC)-induced osteoporosis (GIOP) in Korea.
The Korean Society for Bone and Mineral Research and the Korean College of Rheumatology have developed this guideline based on Guidance for the Development of Clinical Practice Guidelines ver. 1.0 established by the National Evidence-Based Healthcare Collaborating Agency. This guideline was developed by adapting previously published guidelines, and a systematic review and quality assessment were performed.
This guideline applies to adults aged ≥19 years who are using or plan to use GCs. It does not include children and adolescents. An initial assessment of fracture risk should be performed within 6 months of initial GC use. Fracture risk should be estimated using the fracture-risk assessment tool (FRAX) after adjustments for GC dose, history of osteoporotic fractures, and bone mineral density (BMD) results. All patients administered with prednisolone or an equivalent medication at a dose ≥2.5 mg/day for ≥3 months are recommended to use adequate calcium and vitamin D during treatment. Patients showing a moderate-to-high fracture risk should be treated with additional medication for osteoporosis. All patients continuing GC therapy should undergo annual BMD testing, vertebral X-ray, and fracture risk assessment using FRAX. When treatment failure is suspected, switching to another drug should be considered.
This guideline is intended to guide clinicians in the prevention and treatment of GIOP.
制定韩国预防和治疗糖皮质激素（GC）诱导的骨质疏松症（GIOP）的指南和建议。
韩国骨与矿物质研究学会和韩国风湿病学会基于国家循证医疗合作机构制定的《临床实践指南制定指南》第1.0版制定了本指南。本指南通过改编先前发布的指南而制定，并进行了系统评价和质量评估。
本指南适用于正在使用或计划使用糖皮质激素的≥19岁成年人。不包括儿童和青少年。应在开始使用糖皮质激素后的6个月内对骨折风险进行初步评估。在调整糖皮质激素剂量、骨质疏松性骨折病史和骨密度（BMD）结果后，应使用骨折风险评估工具（FRAX）评估骨折风险。所有接受泼尼松龙或等效药物治疗、剂量≥2.5mg/天且持续≥3个月的患者，建议在治疗期间补充足够的钙和维生素D。骨折风险为中度至高度的患者应使用其他骨质疏松症药物进行治疗。所有继续接受糖皮质激素治疗的患者应每年进行骨密度检测、脊椎X线检查，并使用FRAX进行骨折风险评估。怀疑治疗失败时，应考虑换用其他药物。
本指南旨在指导临床医生预防和治疗糖皮质激素诱导的骨质疏松症。
