Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK.
Older Person's Unit, Royal United Hospital NHS Foundation Trust, Bath, BA1 3NG, UK.
Age Ageing. 2022 Apr 1;51(4). doi: 10.1093/ageing/afac044.
Fragility fractures are painful, debilitating, often life-changing and accounted for an estimated 2.4% of pre-pandemic health care spending in the UK. Those who are older, frail and multimorbid have the highest fracture risk and therefore the most to gain from anti-osteoporosis treatments to reduce this risk. Currently, an unacceptable treatment gap exists between those eligible for and those who receive treatment. This commentary discusses the major changes to the new, National Institute for Health and Care Excellence accredited, UK National Osteoporosis Guideline Group (NOGG) guidance (published March 2022) most relevant to the management of older people's bone health. Changes include intervention thresholds; using fracture probabilities from FRAX; for patients too frail to undergo DXA; greater emphasis on vertebral fracture detection and the use of intravenous zoledronate as a first-line anti-osteoporosis therapy; the new concept of 'very high fracture risk' which should prompt consideration of use of parenteral anti-osteoporosis therapy; new guidance regarding anabolic treatment options; concerns regarding denosumab cessation; and the urgent need to get patients with a fragility fracture onto treatment to reduce re-fracture risk with follow-up to check tolerance and ensure adherence.
脆性骨折不仅疼痛、虚弱，而且常常改变生活，在英国，其占疫情前医疗保健支出的 2.4%左右。那些年老、体弱和多病的人骨折风险最高，因此最能从抗骨质疏松治疗中获益，以降低这种风险。目前，有资格接受治疗的人和实际接受治疗的人之间存在不可接受的治疗差距。本文讨论了与老年人骨骼健康管理最相关的新的、获得英国国家卫生与保健优化研究所（NICE）认可的英国国家骨质疏松症指导小组（NOGG）指南（2022 年 3 月发布）的主要变化。变化包括干预阈值；使用来自 FRAX 的骨折概率；对于过于虚弱而无法进行 DXA 的患者；更加重视检测椎体骨折和使用唑来膦酸静脉注射作为一线抗骨质疏松治疗；“极高骨折风险”这一新概念，应促使考虑使用注射用抗骨质疏松治疗；新的关于合成代谢治疗选择的指南；对 denosumab 停药的担忧；以及迫切需要让脆性骨折患者接受治疗，以降低再次骨折的风险，并通过随访检查耐受性和确保依从性。
