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ACR指南:糖皮质激素诱发的骨质疏松症的预防和治疗

已有 2015 次阅读 2017-6-16 07:05 |个人分类:临床指南和病例解析|系统分类:观点评述| style, color

ACR指南:糖皮质激素诱发的骨质疏松症的预防和治疗


ACR指南:糖皮质激素诱发的骨质疏松症的预防和治疗

All adults taking prednisone at a dose of >=2.5 mg/day for >=3 months
Optimize calcium intake (800–1,000 mg/day) and vitamin D intake (600–800 IU/day) and lifestyle modifications (balanced diet, maintaining weight in the recommended range, smoking cessation, regular weight-bearing or resistance training exercise, limiting alcohol intake to 1–2 alcoholic beverages/day) over no treatment or over any of these treatments alone.
Conditional recommendation because of indirect evidence on the impact of lifestyle modifications on fracture risk, low-quality evidence on the impact of calcium and vitamin D on fractures in GC users, and indirect evidence on the benefit of calcium and vitamin D on fracture risk in the general OP population


Adults age >=40 years at low risk of fracture
Optimize calcium and vitamin D intake and lifestyle modifications over treatment with bisphosphonates, teriparatide, denosumab, or raloxifene.
Conditional recommendation for calcium and vitamin D over oral bisphosphonates, teriparatide, and denosumab because of low-quality evidence on additional antifracture benefit of the alternative treatments in this low-risk group, costs, and potential harms
Strong recommendation for calcium and vitamin D over IV bisphosphonates and raloxifene because of low-quality evidence on additional antifracture benefit in this low-risk group and their potential harms


Adults age >=40 years at moderate risk of major fracture

Treat with an oral bisphosphonate over calcium and vitamin D alone.
Treat with an oral bisphosphonate over IV bisphosphonates, teriparatide, denosumab, or raloxifene.
Oral bisphosphonates preferred for safety, cost, and because of lack of evidence of superior antifracture benefits from other OP medications.
Other therapies if oral bisphosphonates are not appropriate, in order of preference:
IV bisphosphonates
Higher risk profile for IV infusion over oral bisphosphonate therapy
Teriparatide
Cost and burden of therapy with daily injections
Denosumab
Lack of safety data in people treated with immunosuppressive agents
Raloxifene (for postmenopausal women in whom none of the medications listed above is appropriate)
Lack of adequate data on benefits (impact on risk of vertebral and hip fractures in GC users) and potential harms (clotting risks, mortality)
Conditional recommendations because of indirect and low-quality evidence comparing benefits and harms of alternative treatments in people with moderate fracture risk


Adults age >=40 years at high risk of fracture
Treat with an oral bisphosphonate over calcium and vitamin D alone.
Treat with an oral bisphosphonate over IV bisphosphonates, teriparatide, denosumab, or raloxifene.
Oral bisphosphonates preferred for safety, cost, and because of lack of evidence of superior antifracture benefits from other OP medications.
Other therapies if oral bisphosphonates are not appropriate, in order of preference:
IV bisphosphonates
Higher risk profile for IV infusion over oral bisphosphonate therapy
Teriparatide
Cost and burden of therapy with daily injections
Denosumab
Lack of safety data in people treated with immunosuppressive agents
Raloxifene (for postmenopausal women in whom none of the medications listed above is appropriate)
Lack of adequate data on benefits (impact on risk of vertebral and hip fractures in GC users) and potential harms (clotting risks, mortality)
Strong recommendation for oral bisphosphonates over calcium and vitamin D alone because of the strength of the indirect evidence of antifracture efficacy and low harms
All other recommendations conditional because of indirect and low-quality evidence comparing benefits and harms of alternative treatments in people with high fracture risk


Adults age <40 years at low risk of fracture
Optimize calcium and vitamin D intake and lifestyle modifications over treatment with bisphosphonates, teriparatide, or denosumab.
Conditional recommendation for calcium and vitamin D over oral bisphosphonates, teriparatide, and denosumab because of low-quality evidence on additional antifracture benefit of the alternative treatments, costs, and potential harms Strong recommendation for calcium and vitamin D over IV bisphosphonates because of low-quality evidence for additional antifracture benefit in this low-risk group and potential harms

Adults age <40 years at moderate-to-high risk of fracture

Treat with an oral bisphosphonate over calcium and vitamin D alone.
Treat with an oral bisphosphonate over IV bisphosphonates, teriparatide, or denosumab.
Oral bisphosphonates preferred for safety, cost, and because of lack of evidence of superior antifracture benefits from other OP medications.
Other therapies if oral bisphosphonates are not appropriate, in order of preference:
IV bisphosphonates
Higher risk profile for IV infusion over oral bisphosphonate therapy
Teriparatide
Cost and burden of therapy with daily injections
Denosumab
Lack of safety data in people treated with immunosuppressive agents
Conditional recommendations because of low- to very low-quality evidence on absolute fracture risk and indirect and low-quality evidence comparing relative harms and benefits of alternative treatments in this age group

指南目录

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2017年最新克罗恩病治疗指南

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