Prevence sekundárních fraktur: multioborové konsenzuální stanovisko ke klinickým doporučením


Autoři: Conley B Robert 1;  Adib Gemma 2;  Robert;  Adler 3;  Kesson E Kristina 4;  Alexander M Ivy 5;  Amenta C Kelly 6;  Blank D Robert 7,8;  Brox Timothy William 9;  Carmody E Emily 10;  Chapman-Novakofski Karen 11;  Clarke L Bart 12;  Cody M Kathleen 13;  Cooper Cyrus 14;  Crandall J Carolyn 15;  Dirschl R Douglas 16;  Eagen J Thomas 17;  Elderkin L Ann 18;  Fujita Masaki 19;  Greenspan L Susan 20;  Halbout Philippe 21;  Hochberg C Marc 22;  Javaid Muhammad 23;  Jeray J Kyle 24;  Kearns E Ann 12;  King Toby 25;  Koinis F Thomas 26;  Koontz Scott Jennifer 27,28;  Kužma Martin 29;  Lindsey Carleen 30;  Lorentzon Mattias 31,32,33;  Lyritis P George 34;  Michaud Boehnke Laura 35;  Miciano Armando 36;  Morin N Suzanne 37;  Mujahid Nadia 38;  Napoli Nicola 39,40;  Olenginski P Thomas 41;  Puzas Edward J 10;  Rizou Stavroula 34;  Rosen J Clifford 42,43;  Saag Kenneth 44;  Thompson Elizabeth 45;  Tosi L Laura 46;  Tracer Howard 47;  Khosla Sundeep 12;  Kiel P Douglas 48
Působiště autorů: Center for Medical Technology Policy, Baltimore, MD, USA 1;  Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA 10;  Division of Nutritional Sciences, University of Illinois, Urbana, IL, USA 11;  Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Ro-chester, MN, USA 12;  American Bone Health, Raleigh, NC, USA 13;  University of Southampton, Southampton, UK 14;  Department of Medicine, University of California, Los Angeles, CA, USA 15;  Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA 16;  National Council on Aging, New York, NY, USA 17;  American Society for Bone and Mineral Research, Washington, DC, USA 18;  Science Department, International Osteoporosis Foundation, Nyon, Switzerland 19;  Osteoporosis Centre, Damascus, Syria 2;  Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA 20;  International Osteoporosis Foundation, Nyon, Switzerland 21;  Division of Rheumatology, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD, USA 22;  Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, USA 23;  Prisma Health Upstate (formerly Greenville Health System), Greenville, SC, USA 24;  US Bone and Joint Initiative, Rosemont, IL, USA 25;  Duke Primary Care Oxford, Oxford, NC, USA 26;  Orthopedics & Sports Medicine, Newton Medical Center, Newton, KS, USA 27;  Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, KS, USA 28;  th Department of Internal Medicine, University Hospital, Comenius University, Bratislava, Slovakia 295;  McGuire VA Medical Center, Richmond, VA, USA 3;  Bones, Backs and Balance, LLC, Bristol Physical Therapy, LLC, Bristol, CT, USA 30;  Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia 31;  Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden 32;  Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 33;  Hellenic Osteoporosis Foundation, Athens, Greece 34;  The University of Texas MD Anderson Cancer Center, Houston, TX, USA 35;  Nevada Rehabilitation Institute, Las Vegas, NV, USA 36;  Department of Medicine, McGill University, Montreal, Canada 37;  Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA 38;  Department of Nutrition and Metabolic Disorders, Campus Bio-Medico University of Rome, Rome, Italy 39;  Lund University and Skåne University Hospital, Lund, Scania, Sweden 4;  Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA 40;  HiROC Program/Rheumatology, Geisinger Health System, Danville, PA, USA 41;  Tufts University School of Medicine, Boston, MA, USA 42;  Maine Medical Center Research Institute, Portland, ME, USA 43;  Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA 44;  National Osteoporosis Foundation, Arlington, VA, USA 45;  Department of Orthopaedic Surgery and Sports Medicine, Children’s National Hospital, Washington, DC, USA 46;  Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA 47;  Harvard Medical School, Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA 48;  UConn School of Nursing, University of Connecticut, Storrs, CT, USA 5;  Department of Physician Assistant Studies, Mercyhurst University, Erie, PA, USA 6;  Department of Endocrinology, Metabolism and Clinical Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA 7;  Garvan Institute of Medical Research, Darlinghurst, NSW, Australia 8;  UCSF Fresno, Fresno, CA, USA 9
Vyšlo v časopise: Clinical Osteology 2020; 25(1): 7-25
Kategorie: Doporučené postupy

Souhrn

Fraktury související s osteoporózou jsou v současnosti nedostatečně léčeny („podléčeny“), a to z části pro mylné informace o doporučených postupech v péči o pacienty a z části pro rozdíly v doporučeních pro léčbu. Aby se zvrátil tento nevyhovující stav a zlepšily se léčebné výsledky pacientů, sestavila Americká společnost pro výzkum kostí a kostního minerálu širokou skupinu zainteresovaných odborníků ke koncipování klinických doporučení k opti­malizaci prevence sekundárních fraktur v populaci osob ve věku 65 let a starších postižených frakturami krčku kosti stehenní nebo obratlů. Tato skupina připravila 13 doporučení (7 primárních a 6 sekundárních) přesvědčivě potvrzených důkazy z odborné literatury. Skupina doporučuje rozšíření a zintenzívnění komunikace s pacienty o problematice rizika fraktur, o mortalitní i morbiditních dopadech fraktur stejně jako o možnostech snížení tohoto rizika. Podle odhadu se může riziko (včetně pádů) objevovat v pravidelných intervalech v závislosti na fyzioterapii nebo ergoterapii, což je očekávatelné. Perorálně, intravenózně i subkutánně aplikované léky jsou účinné a mohou snížit riziko fraktur. Pacienti samozřejmě potřebují edukaci o přínosech i rizicích těchto různě aplikovaných léků, stejně jako o důsledcích neléčení. Perorální bisfosfonáty alendronát a risendronát představují léčbu první volby a jsou všeobecně dobře tolerovány; možné je zvážit i intravenózně podávanou kyselinu zoledronovou nebo subkutánně podávaný denosumab. Anabolika jsou nákladná, ale mohou být pro vybrané pacienty ve vysokém riziku přínosná. Optimální délka farmakoterapie není známa, ale protože je riziko sekundárních fraktur v raném období po fraktuře velmi vysoké, doporučuje se bezodkladná léčba. Samozřejmostí by měla být adekvátní dieta, případně suplementace vitamínem D stejně tak by měl být samozřejmostí přísun kalcia. Jednotlivci léčení na osteoporózu by měli být běžně opakovaně vyšetřováni vzhledem k riziku fraktur a opakovaně informování v rámci pacientské edukace o osteoporóze a riziku fraktur a o monitorování nežádoucích účinků léčby. Pacienti by měli být důrazně přesvědčováni, aby se vyvarovali kouření a co možná nejvíce omezili konzumaci alkoholu, věnovali se pravidelně fyzické aktivitě a přijali a dodržovali strategie prevence. Závěrem doporučení upozorňuje endokrinology a ostatní odborníky na osteoporózu, aby věnovali pozornost jedincům s opakovanými frakturami anebo úbytkem kostní hmoty a také jedincům s komplikujícími komorbiditami (např. hyperparatyreoidizmus nebo chronické onemocnění ledvin).

Klíčová slova:

stárnutí – anabolika – antirezorptiva – osteoporóza – sekundární fraktura prevence


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Štítky
Biochemie Dětská gynekologie Dětská radiologie Dětská revmatologie Endokrinologie Gynekologie a porodnictví Interní lékařství Ortopedie Praktické lékařství pro dospělé Radiodiagnostika Rehabilitace Revmatologie Traumatologie Osteologie
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