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*For medical professionals to read and refer to Focus on New Progress in GIOP Prevention and Treatment As the most common bone disease, osteoporosis is a disease characterized by low bone mass and damage to the microstructure of bone tissue.
Systemic bone disease characterized by increased bone fragility and susceptibility to fractures
.
Osteoporosis is divided into two categories: primary and secondary.
Secondary osteoporosis refers to osteoporosis caused by any metabolic disease or drug or other reasons, among which glucocorticoids are the most common drugs.
.
The 2021 annual meeting of the Rheumatology and Immunology Branch of the Chinese Medical Doctor Association will be held from December 16 to 18.
In this issue, Professor Zhang Xuewu, Department of Rheumatology and Immunology, Peking University People's Hospital, carefully interprets the newly released "2020 Edition of Chinese Glucocorticoid-induced Osteoporosis".
Expert Consensus on Prevention and Treatment of Symptoms (GIOP)"
.
Recommendation 1: For the first time, the applicable population and management principles for GIOP prevention and treatment are clearly stated
.
Applicable population: All adult patients who are expected to require ≥3 months of hormone therapy (any dose, route of administration) need to be prevented and treated for GIOP
.
Management principles: reduce hormone exposure as much as possible under the premise of early, standardized prevention and treatment, regular assessment, and disease controllable
.
Recommendation 2: It is recommended that patients be regularly stratified for fracture risk during the use of hormones
.
It is recommended that during the use of hormone therapy, the clinical data of patients should be collected regularly, and the bone mineral density and fracture risk assessment tool (FRAX) should be used to stratify patients for fracture risk (Table 1)
.
Table 1: Recommendations for risk stratification of osteoporotic fractures in patients receiving glucocorticoid therapy 3: Emphasis on initial assessment and reassessment of fracture risk
.
The initial assessment of fracture risk is performed within 6 months of initiation of hormone therapy and should be reassessed every 12 months in patients who continue to receive hormone therapy (Figure 1, Figure 2)
.
Figure 1: Initial assessment of fracture risk Figure 2: Reassessment of fracture risk Recommendation 4: All patients on hormone therapy for ≥3 months should undergo life>
.
Life>
.
The new version of the consensus recommends that all those who use hormones for a course of more than 3 months: daily supplementation of elemental calcium (1000-1200 mg) vitamin D (600-800 IU) or active vitamin
D.
Recommendation 5: Stratified treatment is proposed for the first time, and the initial treatment plan is selected based on the risk of GIOP fractures
.
People with low fracture risk should adjust their life>
D.
In addition to calcium supplementation and vitamin D supplementation and life>
etc.
Recommendation 6: Increase the recommendation of GIOP prevention and treatment strategies for special populations
.
Special populations (such as women of childbearing age, those receiving super-dose hormone therapy, and organ transplant recipients) should choose GIOP prevention and treatment strategies according to age and risk stratification
.
Since adult patients with organ transplantation will use a variety of immunosuppressants, such as concomitant use of denosumab may lead to aggravation of infection, so the expert consensus does not recommend the use of denosumab at present
.
Recommendation 7: Increase the recommendation for drug switching and maintenance reduction
.
In GIOP follow-up treatment, adult patients who are still on hormonal therapy, fracture after bisphosphonate therapy for ≥18 months, or have a significant decrease in BMD (≥10%/year), conditionally recommend calcium and (active) On the basis of vitamin D, other types of anti-osteoporosis drugs should be used.
If oral bisphosphonates are intolerant or drug compliance is poor, intravenous bisphosphonates can be considered
.
During GIOP follow-up treatment, anti-osteoporotic drugs should be discontinued only in patients who discontinue hormone therapy and whose fracture risk is reassessed as being at low risk of vertebral fractures
.
Recommendation 8: The new version of the expert consensus also attaches great importance to the monitoring and treatment of adverse drug reactions
.
During GIOP treatment, in addition to regular monitoring of bone mineral density and the use of FRAX to assess fracture risk, it is recommended to monitor possible adverse drug reactions and take appropriate measures (Table 2)
.
Table 2: Summary of common anti-GIOP drug adverse reactions and precautions GIOP is the most common clinical secondary osteoporosis, and it is urgent to pay attention to the prevention and treatment of GIOP
.
The new version of the expert consensus emphasizes that the clinical manifestations and clinical characteristics of GIOP should be recognized and paid attention to as soon as possible.
Even low-dose glucocorticoids can lead to loss of bone mass, and the occurrence of fractures may precede the decrease of bone mineral density
.
For the prevention and treatment of GIOP, the new version of the consensus recommends the selection of treatment options based on fracture risk stratification, among which bisphosphonates such as zoledronic acid are recommended for medium and high risk
.
For the drug switching and maintenance reduction of GIOP, the new version of the expert consensus recommends that other anti-osteoporosis drugs should be switched to other anti-osteoporosis drugs when the initial treatment effect is not good, and the use of zoledron can be considered if oral bisphosphonate intolerance or poor drug compliance Acids and other drugs
.
In the follow-up treatment of GIOP, anti-osteoporosis drugs can be discontinued only if hormone therapy is stopped and the fracture risk is reassessed as low risk; for moderate fracture risk, it is recommended to continue anti-osteoporosis drugs; patients with high fracture risk , it is strongly recommended to add anti-osteoporosis drugs on the basis of calcium and vitamin D
.
Systemic bone disease characterized by increased bone fragility and susceptibility to fractures
.
Osteoporosis is divided into two categories: primary and secondary.
Secondary osteoporosis refers to osteoporosis caused by any metabolic disease or drug or other reasons, among which glucocorticoids are the most common drugs.
.
The 2021 annual meeting of the Rheumatology and Immunology Branch of the Chinese Medical Doctor Association will be held from December 16 to 18.
In this issue, Professor Zhang Xuewu, Department of Rheumatology and Immunology, Peking University People's Hospital, carefully interprets the newly released "2020 Edition of Chinese Glucocorticoid-induced Osteoporosis".
Expert Consensus on Prevention and Treatment of Symptoms (GIOP)"
.
Recommendation 1: For the first time, the applicable population and management principles for GIOP prevention and treatment are clearly stated
.
Applicable population: All adult patients who are expected to require ≥3 months of hormone therapy (any dose, route of administration) need to be prevented and treated for GIOP
.
Management principles: reduce hormone exposure as much as possible under the premise of early, standardized prevention and treatment, regular assessment, and disease controllable
.
Recommendation 2: It is recommended that patients be regularly stratified for fracture risk during the use of hormones
.
It is recommended that during the use of hormone therapy, the clinical data of patients should be collected regularly, and the bone mineral density and fracture risk assessment tool (FRAX) should be used to stratify patients for fracture risk (Table 1)
.
Table 1: Recommendations for risk stratification of osteoporotic fractures in patients receiving glucocorticoid therapy 3: Emphasis on initial assessment and reassessment of fracture risk
.
The initial assessment of fracture risk is performed within 6 months of initiation of hormone therapy and should be reassessed every 12 months in patients who continue to receive hormone therapy (Figure 1, Figure 2)
.
Figure 1: Initial assessment of fracture risk Figure 2: Reassessment of fracture risk Recommendation 4: All patients on hormone therapy for ≥3 months should undergo life>
.
Life>
.
The new version of the consensus recommends that all those who use hormones for a course of more than 3 months: daily supplementation of elemental calcium (1000-1200 mg) vitamin D (600-800 IU) or active vitamin
D.
Recommendation 5: Stratified treatment is proposed for the first time, and the initial treatment plan is selected based on the risk of GIOP fractures
.
People with low fracture risk should adjust their life>
D.
In addition to calcium supplementation and vitamin D supplementation and life>
etc.
Recommendation 6: Increase the recommendation of GIOP prevention and treatment strategies for special populations
.
Special populations (such as women of childbearing age, those receiving super-dose hormone therapy, and organ transplant recipients) should choose GIOP prevention and treatment strategies according to age and risk stratification
.
Since adult patients with organ transplantation will use a variety of immunosuppressants, such as concomitant use of denosumab may lead to aggravation of infection, so the expert consensus does not recommend the use of denosumab at present
.
Recommendation 7: Increase the recommendation for drug switching and maintenance reduction
.
In GIOP follow-up treatment, adult patients who are still on hormonal therapy, fracture after bisphosphonate therapy for ≥18 months, or have a significant decrease in BMD (≥10%/year), conditionally recommend calcium and (active) On the basis of vitamin D, other types of anti-osteoporosis drugs should be used.
If oral bisphosphonates are intolerant or drug compliance is poor, intravenous bisphosphonates can be considered
.
During GIOP follow-up treatment, anti-osteoporotic drugs should be discontinued only in patients who discontinue hormone therapy and whose fracture risk is reassessed as being at low risk of vertebral fractures
.
Recommendation 8: The new version of the expert consensus also attaches great importance to the monitoring and treatment of adverse drug reactions
.
During GIOP treatment, in addition to regular monitoring of bone mineral density and the use of FRAX to assess fracture risk, it is recommended to monitor possible adverse drug reactions and take appropriate measures (Table 2)
.
Table 2: Summary of common anti-GIOP drug adverse reactions and precautions GIOP is the most common clinical secondary osteoporosis, and it is urgent to pay attention to the prevention and treatment of GIOP
.
The new version of the expert consensus emphasizes that the clinical manifestations and clinical characteristics of GIOP should be recognized and paid attention to as soon as possible.
Even low-dose glucocorticoids can lead to loss of bone mass, and the occurrence of fractures may precede the decrease of bone mineral density
.
For the prevention and treatment of GIOP, the new version of the consensus recommends the selection of treatment options based on fracture risk stratification, among which bisphosphonates such as zoledronic acid are recommended for medium and high risk
.
For the drug switching and maintenance reduction of GIOP, the new version of the expert consensus recommends that other anti-osteoporosis drugs should be switched to other anti-osteoporosis drugs when the initial treatment effect is not good, and the use of zoledron can be considered if oral bisphosphonate intolerance or poor drug compliance Acids and other drugs
.
In the follow-up treatment of GIOP, anti-osteoporosis drugs can be discontinued only if hormone therapy is stopped and the fracture risk is reassessed as low risk; for moderate fracture risk, it is recommended to continue anti-osteoporosis drugs; patients with high fracture risk , it is strongly recommended to add anti-osteoporosis drugs on the basis of calcium and vitamin D
.
