School of Medicine, Keele University, David Weatherall Building, Newcastle-Under-Lyme, ST5 5BG, UK.
Haywood Academic Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke-On-Trent, ST6 7AG, UK.
Osteoporos Int. 2023 Oct;34(10):1711-1718. doi: 10.1007/s00198-023-06806-7. Epub 2023 Jun 9.
Worldwide, many people who would benefit from osteoporosis drugs are not offered or receiving them, resulting in an osteoporosis care gap. Adherence with bisphosphonates is particularly low. This study aimed to identify stakeholder research priorities relating to bisphosphonate treatment regimens for prevention of osteoporotic fractures.
A three-step approach based on the James Lind Alliance methodology for identification and prioritisation of research questions was used. Research uncertainties were gathered from a large programme of related research studies about bisphosphonate regimens and from recent published international clinical guidelines. Clinical and public stakeholders refined the list of uncertainties into research questions. The third step prioritised the questions using a modified nominal group technique.
In total, 34 draft uncertainties were finalised into 33 research questions by stakeholders. The top 10 includes questions relating to which people should be offered intravenous bisphosphonates first line (1); optimal duration of treatment (2); the role of bone turnover markers in treatment breaks (3); support patient need for medicine optimisation (4); support primary care practitioner need regarding bisphosphonates (5); comparing zoledronate given in community vs hospital settings (6); ensuring quality standards are met (7); the long-term model of care (8); best bisphosphonate for people aged under 50 (9); and supporting patient decision-making about bisphosphonates (10).
This study reports, for the first time, topics of importance to stakeholders in the research of bisphosphonate osteoporosis treatment regimens. These findings have implications for research into implementation to address the care gap and education of healthcare professionals. Using James Lind Alliance methodology, this study reports prioritised topics of importance to stakeholders in the research of bisphosphonate treatment in osteoporosis. The priorities address how to better implement guidelines to address the care gap, understanding patient factors influencing treatment selection and effectiveness, and how to optimise long-term care.
在世界范围内，许多需要骨质疏松药物治疗的人没有得到或接受治疗，导致骨质疏松护理存在差距。双膦酸盐的依从性特别低。本研究旨在确定与预防骨质疏松性骨折的双膦酸盐治疗方案相关的利益相关者研究重点。
采用基于 James Lind 联盟方法的三步法确定和优先考虑研究问题。从关于双膦酸盐方案的大量相关研究和最近发表的国际临床指南中收集研究不确定性。临床和公众利益相关者将不确定性清单细化为研究问题。第三步使用改良的名义小组技术对问题进行优先排序。
共有 34 项草案不确定性最终由利益相关者确定为 33 项研究问题。前 10 名包括关于应优先向哪些人提供静脉内双膦酸盐作为一线治疗（1）；最佳治疗持续时间（2）；骨转换标志物在治疗中断中的作用（3）；支持患者对药物优化的需求（4）；支持初级保健医生对双膦酸盐的需求（5）；比较社区和医院环境下给予唑来膦酸（6）；确保达到质量标准（7）；长期护理模式（8）；50 岁以下人群最佳双膦酸盐（9）；以及支持患者关于双膦酸盐的决策（10）。
这是首次报告利益相关者在双膦酸盐骨质疏松治疗方案研究中的重要主题。这些发现对研究实施以解决护理差距和教育医疗保健专业人员具有影响。本研究采用 James Lind 联盟方法，报告了骨质疏松症双膦酸盐治疗研究中利益相关者重视的优先事项。这些重点解决了如何更好地实施指南以解决护理差距，了解影响治疗选择和效果的患者因素，以及如何优化长期护理的问题。
