诊断学理论与实践

诊断学理论与实践 ›› 2023, Vol. 22 ›› Issue (03): 230-233.doi: 10.16150/j.1671-2870.2023.03.04

• 指南解读 • 上一篇    下一篇

中国《原发性骨质疏松症诊疗指南(2022版)》要点解读

章振林1(), 岳华1, 李梅2, 夏维波2   

  1. 1.上海交通大学医学院附属第六人民医院 骨质疏松和骨病专科 上海市骨疾病临床研究中心，上海 200233
    2.中国医学科学院北京协和医院 内分泌科，北京 100730
  • 收稿日期:2023-05-01 出版日期:2023-06-25 发布日期:2023-11-17
  • 通讯作者: 章振林 E-mail：zhangzl@sjtu.edu.cn
  • 基金资助:
    国家自然科学基金资助项目(81770874);国家自然科学基金资助项目(81974126);国家自然科学基金资助项目(82270932)

Interpretation of guidelines for the diagnosis and treatment of primary osteoporosis (2022 version) in China: essential introduction

ZHANG Zhenlin1(), YUE Hua1, LI Mei2, XIA Weibo2   

  1. 1. Shanghai Clinical Research Center for Osteoporosis and Osteopathy, Affiliated Sixth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
    2. Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2023-05-01 Online:2023-06-25 Published:2023-11-17

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摘要：

我国人口老龄化程度不断加深，积极应对是医药卫生面临的重要问题。骨质疏松及由此引发的骨折尤其值得关注。为了进一步规范原发性骨质疏松症的诊疗，中华医学会骨质疏松和骨矿盐疾病分会针对中国人群流行病学特点和发病机制，结合国内、外高质量的医学研究证据，制定并发布了《原发性骨质疏松症诊疗指南（2022版）》。本文将结合指南的要点、循证医学证据以及我国临床实践，专注于新版指南中关于“骨折风险分层及治疗选择”以及“抗骨质疏松症药物疗程”2个关键临床问题的解读。关于骨折风险，本指南中将其为分高骨折和极高骨折风险，取消了低、中风险分类，对极高骨折风险指标之一“近期发生骨折”，“近期“定义为“24个月”；鉴于FRAX模型低估中国患者骨折风险，提出临床需制定操作性强的骨折风险分层判定标准。关于药物治疗，对于使用双膦酸盐类药物的患者，应充分评估，才能进入药物假期，且仍需定期随访；尽管美国食品药品管理局（Food and Drug Administration，FDA）取消了特立帕肽致骨肉瘤的警示及24个月的疗程限制，但我国该药的使用说明书提示疗程依然为24个月。本次指南立足于国内外的高质量循证医学证据，可为临床提供参考及研究方向。

关键词: 原发性骨质疏松, 风险分层, 双能X线吸收法

Abstract:

China is now witnessing an accelerated aging process，and active reaction is an important issue that we are facing. Osteoporosis and the resulting fractures are particularly noteworthy. In order to further standardize the diagnosis and treatment of primary osteoporosis, the Osteoporosis and Bone Mineral Disease Branch of the Chinese Medical Association has developed and released the “Guidelines for the Diagnosis and Treatment of Primary Osteoporosis (2022 Version)” based on the epidemiological characteristics and pathogenesis of the Chinese population, which combined high-quality medical research evidence from both domestic and foreign sources. Based on evidence-based medicine evidence, and clinical practice in China, this article will focus on the interpretation of two key clinical issues in the new version of the guidelines, namely “fracture risk stratification and treatment selection” and “treatment course of anti-osteoporosis drugs”. Regarding the risk of fractures, this guideline divides it into high and extremely high fracture risks, cancels the classification of low and medium risks, and for one of the extremely high fracture risk indicators “recent brittle fractures”，defines “recent” as “24 months”.Given that the FRAX model underestimates the fracture risk of Chinese patients, it is proposed to develop a highly operational fracture risk stratification criteria in clinical practice. Regarding drug treatment, patients who use bisphosphonates should be fully evaluated before entering the medication holiday, and regular follow-up is still required. Although the Food and Drug Administration (FDA) of the United States has lifted the warning of osteosarcoma and 24- month treatment limit for terlipide, the user manual of the drug in China still suggests a treatment period of 24 months. This guideline is based on high-quality evidence-based medical evidence both domestically and internationally, and may provide reference and research directions for clinical practice.

Key words: Primary osteoporosis, Risk stratification, Dual-energy X-ray absorptiometry

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