Guideline for the rehabilitation treatment of osteoporosis (2024 edition)_Chinese Journal of Evidence-Based Medicine

Authors：

 Chinese Society of Physical Medicine and Rehabilitation

Corresponding author：

Chinese Society of Physical Medicine and Rehabilitation, Email: hxkfhcq@126.com

Keywords：

Osteoporosis; Rehabilitation assessment; Rehabilitation treatment; Clinical practice guideline; Evidence-based medicine

DOI：

10.7507/1672-2531.202403173

Video：

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Abstract Full text Figures/Tables Video References Cited by

Osteoporosis (OP) is one of the most serious health problems, causing a huge economic burden to patients, families and society. OP rehabilitation treatment plays an important role in pain-relieving, reducing the risk of fracture, improving the ability of daily activities, and promoting the healing of osteoporosis fractures, and has been increasingly valued and recommended by domestic and foreign guidelines. This guideline was updated based on the Chinese expert consensus on rehabilitation intervention for primary osteoporosis 2019 editions, and was initiated by Chinese Society of Physical Medicine and Rehabilitation professor HE Chengqi, Chairman of the Chinese Medical Association Physical Medicine and Rehabilitation Branch. This guideline development was guided by domestic and international guideline development methods and principles, and selected through clinical issue screening and deconstruction, and two rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the grading of recommendations assessment, development and evaluation (GRADE) was used based on the best available evidence. The ICF is a theoretical framework based on the best available evidence, and uses the GRADE method to grade the quality of evidence and recommendations, and reports them according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT), taking into account patients’ preferences and values and the needs of Chinese clinical practice, resulting in 22 recommendations in 7 aspects of rehabilitation assessment, physical agents therapy, occupational therapy, rehabilitation brace, cognitive behavior and psychological therapy, traditional Chinese medicine therapy and health education to systematically standardize the rehabilitation of osteoporosis.

Citation： Chinese Society of Physical Medicine and Rehabilitation. Guideline for the rehabilitation treatment of osteoporosis (2024 edition). Chinese Journal of Evidence-Based Medicine, 2024, 24(6): 626-636. doi: 10.7507/1672-2531.202403173 Copy

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2. 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2022). 中国全科医学, 2023, 26(14): 1671-1691.
3. Salari N, Ghasemi H, Mohammadi L, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res, 2021, 16(1): 609.
4. 中华医学会骨质疏松和骨矿盐疾病分会. 中国骨质疏松症流行病学调查及"健康骨骼"专项行动结果发布. 中华骨质疏松和骨矿盐疾病杂志, 2019, 12(4): 317-318.
5. 中国健康促进基金会骨质疏松防治中国白皮书编委会. 骨质疏松症中国白皮书. 中华健康管理学杂志, 2009, 3(3): 148-154.
6. Oral A, Küçükdeveci AA, Varela E, et al. Osteoporosis. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM section professional practice committee. Eur J Phys Rehabil Med, 2013, 49(4): 565-577.
7. Clynes MA, Harvey NC, Curtis EM, et al. The epidemiology of osteoporosis. Br Med Bull, 2020, 133(1): 105-117.
8. LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int, 2022, 33(10): 2049-2102.
9. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract, 2020, 26(Suppl 1): 1-46.
10. Morin SN, Feldman S, Funnell L, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ, 2023, 195(39): E1333-E1348.
11. 中华医学会物理医学与康复学分会, 中国老年学和老年医学学会骨质疏松康复分会. 原发性骨质疏松症康复干预中国专家共识. 中华物理医学与康复杂志, 2019, 41(1): 1-5.
12. 陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022版). 中华医学杂志, 2022, 102(10): 697-703.
13. WHO. WHO handbook for guideline development. 2014.
14. 蒋朱明, 詹思延, 贾晓巍, 等. 制订/修订《临床诊疗指南》的基本方法及程序. 中华医学杂志, 2016, 96(4): 250-253.
15. Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: introduction. BMJ, 2016, 353: i2016.
16. Chen Y, Yang K, Marušić A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Z Evid Fortbild Qual Gesundhwes, 2017, 11: 127-128.
17. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
18. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
19. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
20. Whiting PF, Weswood ME, Rutjes AW, et al. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol, 2006, 6: 9.
21. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-E842.
22. 王吉耀, 王强, 王小钦, 等. 中国临床实践指南评价体系的制定与初步验证. 上海医学, 2018, 41(6): 321-326.
23. Paolucci T, Saraceni VM, Piccinini G. Management of chronic pain in osteoporosis: challenges and solutions. J Pain Res, 2016, 9: 177-186.
24. Pickering ME, Javier RM, Malochet S, et al. Osteoporosis treatment and pain relief: a scoping review. Eur J Pain, 2024, 28(1): 3-20.
25. Alonso Pérez JL, Martín Pérez S, Battaglino A, et al. An up-date of the muscle strengthening exercise effectiveness in postmenopausal women with osteoporosis: a qualitative systematic review. J Clin Med, 2021, 10(11): 2229.
26. Lee JG, Kim WJ, Kyoung KJ. Effects of resistance exercise program on pain, stress, range of motion, and body composition of older adults: a randomized controlled trial. Altern Ther Health Med. 2022, 28(7): 95-103.
27. Jensen AM, Stevens RJ, Burls AJ. Estimating the accuracy of muscle response testing: two randomised-order blinded studies. BMC Complement Altern Med, 2016, 16(1): 492.
28. Xie H, Loh S, Shan CP, et al. Osteoporosis in adults with mental illnesses: a systematic review. JBI Libr Syst Rev, 2012, 10(56 Suppl): 1-20.
29. Stamm TA, Pieber K, Blasche G, et al. Health care utilisation in subjects with osteoarthritis, chronic back pain and osteoporosis aged 65 years and more: mediating effects of limitations in activities of daily living, pain intensity and mental diseases. Wien Med Wochenschr, 2014, 164(7-8): 160-166.
30. Imai T, Tanaka S, Kawakami K, et al. Health state utility values and patient-reported outcomes before and after vertebral and non-vertebral fractures in an osteoporosis clinical trial. Osteoporos Int, 2017, 28(6): 1893-1901.
31. Cizza G, Primma S, Coyle M, et al. Depression and osteoporosis: a research synthesis with meta-analysis. Horm Metab Res, 2010, 42(7): 467-482.
32. Chen K, Wang T, Tong X, et al. Osteoporosis is associated with depression among older adults: a nationwide population-based study in the USA from 2005 to 2020. Public Health, 2024, 226: 27-31.
33. Khan SN, Craig L, Wild R. Osteoporosis: therapeutic guidelines. Guidelines for practice management of osteoporosis. Clin Obstet Gynecol, 2013, 56(4): 694-702.
34. Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos, 2022, 17(1): 58.
35. Tanner SB. Dual-energy X-ray absorptiometry in clinical practice: new guidelines and concerns. Curr Opin Rheumatol, 2011, 23(4): 385-388.
36. Malgo F, Hamdy NAT, Ticheler CHJM, et al. Value and potential limitations of vertebral fracture assessment (VFA) compared to conventional spine radiography: experience from a fracture liaison service (FLS) and a meta-analysis. Osteoporos Int, 2017, 28(10): 2955-2965.
37. Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res, 1993, 8(9): 1137-1148.
38. Govindarajan V, Diaz A, Perez-Roman RJ, et al. Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis. Neurosurg Focus, 2021, 50(6): E9.
39. Wilhelm M, Roskovensky G, Emery K, et al. Effect of resistance exercises on function in older adults with osteoporosis or osteopenia: a systematic review. Physiother Can, 2012, 64(4): 386-394.
40. Tosteson AN, Hammond CS. Quality-of-life assessment in osteoporosis: health-status and preference-based measures. Pharmacoeconomics, 2002, 20(5): 289-303.
41. Takahashi H. Assessment of health related quality of life in osteoporotic patients. Nihon Rinsho, 2002, 60(Suppl 3): 479-484.
42. Lix LM, Acan Osman B, Adachi JD, et al. Measurement equivalence of the SF-36 in the Canadian multicentre osteoporosis study. Health Qual Life Outcomes, 2012, 10: 29.
43. Balabem ACCP, Oliveira MN, Herval ÁM, et al. Quality of life of family health strategy professionals: a systematic review. Sao Paulo Med J, 2021, 139(4): 331-340.
44. Hu J, Zheng W, Zhao D, et al. Health-related quality of life in men with osteoporosis: a systematic review and meta-analysis. Endocrine, 2021, 74(2): 270-280.
45. Wei F, Hu Z, He R, et al. Effects of balance training on balance and fall efficacy in patients with osteoporosis: a systematic review and meta-analysis with trial sequential analysis. J Rehabil Med, 2023, 55: jrm00390.
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Chinese Journal of Evidence-Based Medicine

Guideline for the rehabilitation treatment of osteoporosis (2024 edition)

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