Rheumatology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Departament of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Catalonia, Spain.
Arch Osteoporos. 2023 Aug 23;18(1):110. doi: 10.1007/s11657-023-01318-7.
The OSARIDELPHI study evaluated the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. The results provide expert-based recommendations for prevention, diagnosis, and treatment related to fracture risk. Therefore, the study facilitates clinical decision-making for managing this patient's profile.
To evaluate the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain.
A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with assessments on a 9-point Likert scale. Item selection was based on acceptance by ≥ 66.6% of panel experts and the agreement of the scientific committee. In round 2, the same panelists evaluated non-consensus items in round 1.
A total of 80 panelists participated in round 1; of these, 78 completed the round 2 survey. In round 1, 122 items from 4 dimensions (definition of fracture risk: 11 items, prevention and diagnosis: 38 items, choice of treatment: 24 items, and treatment-associated quality of life: 49 items) were evaluated. The consensus was reached for 90 items (73.8%). Panelists agreed that categorizing high risk, very high risk, or imminent risk determines secondary prevention actions (97.5%). Experts agreed that treatment with bone-forming drugs should be considered in case of a very high risk of fracture, and a sequential change to antiresorptive drugs should be made after 1-2 years (97.5%). Panelists also recommended corrective action plans for non-adherent patients to improve adherence (97.5%). A total of 131 items were finally accepted after round 2.
This Delphi study provides expert-based recommendations on clinical decision-making for managing patients with osteoporosis at high risk of fracture.
评估西班牙骨质疏松症专家在处理高风险骨折患者方面的管理意见的一致性。
采用两轮在线德尔菲法调查。第一轮，小组成员根据 9 分制量表评估他们对评估的一致性程度。项目选择基于≥ 66.6%的专家组专家和科学委员会的同意。在第二轮中，相同的小组成员评估了第一轮中的非共识项目。
共有 80 名小组成员参加了第一轮；其中 78 名完成了第二轮调查。在第一轮中，从 4 个维度评估了 122 个项目（骨折风险定义：11 个项目；预防和诊断：38 个项目；治疗选择：24 个项目；治疗相关生活质量：49 个项目）。达成共识的项目有 90 项（73.8%）。小组成员一致认为，分类高风险、极高风险或即将发生的风险决定了二级预防措施（97.5%）。专家一致认为，对于极高骨折风险的患者，应考虑使用成骨药物治疗，且应在 1-2 年后进行抗吸收药物的序贯更换（97.5%）。专家还建议制定针对不依从患者的纠正行动计划，以提高依从性（97.5%）。经过第二轮后，共接受了 131 项建议。
本德尔菲研究提供了基于专家的建议，用于管理有高骨折风险的骨质疏松症患者的临床决策。
