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循证拉丁美洲临床实践指南:糖皮质激素性骨质疏松症的预防、诊断、治疗和管理。2022 年更新版:本指南由国际骨质疏松基金会(IOF)的国家学会委员会(CNS)和科学顾问委员会(CSA)编写。

Evidence based Latin American Guidelines of clinical practice on prevention, diagnosis, management and treatment of glucocorticoid induced osteoporosis. A 2022 update : This manuscript has been produced under the auspices of the Committee of National Societies (CNS) and the Committee of Scientific Advisors (CSA) of the International Osteoporosis Foundation (IOF).

机构信息

Investigaciones Reumatológicas y Osteológicas (IRO). Collaborating Centre WHO, Buenos Aires, Argentina.

International Osteoporosis Foundation (IOF), Latin America Region.

出版信息

Aging Clin Exp Res. 2022 Nov;34(11):2591-2602. doi: 10.1007/s40520-022-02261-2. Epub 2022 Nov 9.

Abstract

Guidelines and recommendations developed and endorsed by the International Osteoporosis Foundation (IOF) are intended to provide guidance for particular pattern of practice for physicians who usually prescribe glucocorticoid (GC) therapy, and not to dictate the care of a particular patient. Adherence to the recommendations within this guideline is voluntary and the ultimate determination regarding their application should be made by the physician in light of each patient's circumstances. Guidelines and recommendations are intended to promote a desirable outcome but cannot guarantee any specific outcome. This guideline and its recommendations are not intended to dictate payment, reimbursement or insurance decisions. Guidelines and recommendations are subjected to periodic revisions as a consequence of the evolution of medicine, technology and clinical practice. A panel of Latin American (LATAM) experts specialized in osteoporosis with recognized clinical experience in managing patients with glucocorticoid-induced osteoporosis (GIO) met to produce evidence-based LATAM recommendations for the diagnosis and management of GIO. These guidelines are particularly intended to general practitioners and primary care physicians who prescribe GC treatments in LATAM to guide their daily clinical practice in terms of evaluation, prevention and treatment of GIO. These recommendations were based on systematic literature review using MEDLINE, EMBASE, SCOPUS and COCHRANE Library database during the period from 2012 to 2021. Randomized clinical trials (RCT), systematic reviews of RCT, controlled observational studies, guidelines and consensus were considered. Based on the review and expert opinion the panel members voted recommendations during two successive rounds of voting by panel members. Agreements for each statement were considered if a concordance of at least 70% was achieved following Delphi methodology. Grading of recommendations was made according to the Oxford Centre for the Evidence-based Medicine (EBM) criteria. Among five GIO guidelines and consensus initially identified, two of them (American College of Rheumatology 2017 and the Brazilian Guidelines 2021) were selected for comparison considering the latter as the most current guides in the LATAM region. Based on this methodology fifty statements were issued. All of them but four (1.20, 1.21, 1.23 and 4.2) attained agreement.

摘要

国际骨质疏松基金会(IOF)制定和认可的指南和建议旨在为通常开具糖皮质激素(GC)治疗药物的医生提供特定实践模式的指导,而不是规定特定患者的护理。本指南中的建议的遵循是自愿的,最终应根据每个患者的具体情况由医生决定是否采用。指南和建议旨在促进理想的结果,但不能保证任何特定的结果。本指南及其建议并非旨在决定支付、报销或保险决定。由于医学、技术和临床实践的发展,指南和建议会定期修订。一组专门研究骨质疏松症的拉丁美洲(LATAM)专家,具有管理糖皮质激素诱导性骨质疏松症(GIO)患者的临床经验,专门开会制定基于证据的 LATAM 建议,用于 GIO 的诊断和管理。这些指南特别针对在 LATAM 地区开具 GC 治疗药物的全科医生和初级保健医生,以指导他们在 GIO 的评估、预防和治疗方面的日常临床实践。这些建议是基于 2012 年至 2021 年期间使用 MEDLINE、EMBASE、SCOPUS 和 COCHRANE 图书馆数据库进行的系统文献综述制定的。考虑了随机临床试验(RCT)、RCT 的系统评价、对照观察性研究、指南和共识。根据审查和专家意见,小组成员在两轮连续投票中对建议进行了投票。如果采用 Delphi 方法达成至少 70%的一致性,则认为对每个陈述的达成协议。根据牛津循证医学中心(EBM)标准对建议进行分级。在最初确定的五项 GIO 指南和共识中,选择了其中两项(美国风湿病学会 2017 年和巴西指南 2021 年)进行比较,因为后者是 LATAM 地区最新的指南。根据这种方法,提出了五十项声明。除了四项(1.20、1.21、1.23 和 4.2)之外,所有声明都达成了一致。

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