UGC Pediatría. Sección Reumatología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain.
Unidad de Reumatología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain.
Pediatr Rheumatol Online J. 2020 Feb 24;18(1):20. doi: 10.1186/s12969-020-0411-9.
Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology.
An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included.
Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted.
In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future.
由于患有慢性病的患者存活率提高以及可损害骨骼的药物使用增加，儿童骨质疏松症的发病率正在增加。最近对儿童骨质疏松症定义的修改，以及缺乏关于其诊断和治疗的指南或国家共识，导致了治疗这种疾病的方法存在很大差异。出于这些原因，西班牙儿科风湿病学会的成骨不全和儿童骨质疏松症工作组呼吁制定指南，以规范该病理的临床实践。
由 6 名儿科医生和 5 名风湿病学家组成的专家小组进行了定性文献回顾，并根据现有证据提供了建议，如果没有证据，则根据他们自己的经验提供建议。每个部分的证据水平均使用牛津循证医学中心（CEBM）系统确定。对于证据水平为 IV 或 V 的建议进行了 Delphi 调查。该调查发送给了 SERPE 的所有成员。纳入了所有同意率高于或等于 70%的建议。
共获得 51 条建议，分为 8 个部分。其中 24 条具有 4 或 5 级证据水平，因此进行了 Delphi 调查。这是通过电子方式提交的，并收到了 40%的回复率。提交给 Delphi 轮的所有建议均获得了 70%或更高的一致性水平，因此被接受。
总之，我们根据现有证据和专家临床经验，为预防、诊断和治疗继发性儿童骨质疏松症提供了指南。我们相信它可以作为一种有用的工具，有助于为这种病理的临床实践标准化做出贡献。预防措施、早期诊断和适当的治疗方法对于改善儿童和青少年的骨骼健康以及他们未来成为成年人后的骨骼健康至关重要。
