Clinical intervention guideline for using of anti-osteoporosis drugs in postoperative fragile hip fractures in China (2023 Edition)

doi:10.3877/cma.j.issn.1674-134X.2023.06.001

Abstract

Abstract:

Hip osteoporosis fracture (also known as hip brittle fracture) refers to a fracture that occurs after minor trauma resulted from a serious consequence of osteoporosis. Hip fracture is also a common type of fracture in the elderly. In recent years, the incidence of hip fracture in China has shown a significant upward trend. The surgical treatment methods for elderly hip fractures commonly include internal fixation or hip joint replacement. However, if osteoporosis hip fractures are not diagnosed correctly in time and receive standardized, effective, and comprehensive anti osteoporosis treatment after surgery, there would be a great risk of re-fracture and prosthesis loosening. Therefore, developing personalized treatment plans target to the specific risks and health status of patients and using of anti osteoporosis drugs timely and correctly are key to reducing postoperative complications. This guideline aims to provide clinical guidance on the selection and management of anti-osteoporosis drugs after osteoporosis hip fracture surgery, help clinician to choose drug treatment plans more reasonably, help patients with hip fracture surgery to recover as soon as possible, reduce bedridden time, and reduce the incidence of re-fracture and prosthesis loosening.

Key words: Hip fracture, Osteoporosis, Drug therapy, Guideline

The Joint Surgery Branch of the Chinese Orthopedic Association, Guangdong’s Medical Association of Osteoporosis And Bone Mineral Research, Foshan Shunde 3rd Peoele’s Hospital. Clinical intervention guideline for using of anti-osteoporosis drugs in postoperative fragile hip fractures in China (2023 Edition)[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 751-764.

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References 152

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推荐强度分级	定义
强推荐(1)	明确显示干预措施利大于弊
弱推荐(2)	利弊不确定或干预措施可能利大于弊
专家建议(good practice statement, GPS)	基于非直接证据或专家意见、经验形成的推荐

推荐强度分级	定义
强推荐(1)	明确显示干预措施利大于弊
弱推荐(2)	利弊不确定或干预措施可能利大于弊
专家建议(good practice statement, GPS)	基于非直接证据或专家意见、经验形成的推荐

证据质量分级	定义
高(A)	非常有把握观察值接近真实值
中(B)	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低(C)	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	对观察值几乎没有把握：观察值与真实值可能有极大差别

证据质量分级	定义
高(A)	非常有把握观察值接近真实值
中(B)	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低(C)	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	对观察值几乎没有把握：观察值与真实值可能有极大差别

骨折风险分层	双膦酸盐类		地舒单抗^[152]	特立帕肽	降钙素(协同镇痛)	活性维生素D3维生素K2^[151]	基础措施
骨折风险分层	口服类	注射类	地舒单抗^[152]	特立帕肽	降钙素(协同镇痛)	活性维生素D3维生素K2^[151]	基础措施
髋部脆性骨折内固定术后极高骨折风险	一般	推荐	推荐	推荐	推荐	推荐	推荐
再次髋部脆性骨折内固定术后极高骨折风险	一般	推荐	推荐	推荐	推荐	推荐	推荐
髋部脆性骨折假体置换术后极高骨折风险	推荐	推荐	推荐	推荐	推荐	推荐	推荐
超高龄或肾功能不全的髋部脆性骨折内固定术后极高骨折风险	不推荐	不推荐	推荐(低钙血症患者禁用)	一般或不推荐	推荐(低钙血症患者禁用)	推荐(高磷血症患者禁用)	一般(高钙血症患者禁用)

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