Clinical practice guidelines provide helpful information for managing patients with metabolic bone disease. Good guidelines are based on the best available medical evidence; however, guidelines from different societies can conflict. Additionally, it is not possible for a guideline to anticipate the vast variability of circumstances, comorbidities, previous medical experiences, cultural differences, and preferences in real-world patients. Bone Health TeleECHO is a strategy for sharing knowledge on the care of patients with skeletal diseases through ongoing interactive videoconferences. We report three cases based on those presented at Bone Health TeleECHO, where, through discussion, treatment outside of commonly used guidelines was ultimately recommended. Guidelines developed by different organizations may provide "evidence-based" or "informed" recommendations which do not account for the variability of clinical circumstances encountered in the care of individual patients. This highlights the importance of Bone Health TeleECHO, where healthcare professionals can share knowledge, individualize treatment decisions, and improve patient care.Learning objectives At the end of this activity participants should be able to:• Distinguish between the onset and off of bisphosphonates versus other medications used in the prevention and treatment of osteoporosis and how this affects choice of a "drug holiday."• Understand the limitations of clinical practices guidelines in the care of an individual patient and how interactive video conferencing can assist with decision making.• Recognize that patients treated with glucocorticoids at high risk for fracture can benefit from more aggressive interventions for osteoporosis.

中文翻译：

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骨健康 TeleECHO 的经验教训：在指南冲突时做出治疗决定。

临床实践指南为管理代谢性骨病患者提供了有用的信息。良好的指南基于现有的最佳医学证据；但是，来自不同社会的指导方针可能会发生冲突。此外，指南不可能预测现实世界患者的情况、合并症、既往医疗经验、文化差异和偏好的巨大差异。Bone Health TeleECHO 是一项通过正在进行的交互式视频会议分享有关骨骼疾病患者护理知识的策略。我们根据 Bone Health TeleECHO 上提出的案例报告了三个案例，通过讨论，最终推荐了常用指南之外的治疗。不同组织制定的指南可能提供“循证” 或“知情的”建议，这些建议没有考虑到在护理个体患者时遇到的临床情况的可变性。这凸显了骨骼健康 TeleECHO 的重要性，医疗保健专业人员可以在其中分享知识、个性化治疗决策并改善患者护理。学习目标 在本活动结束时，参与者应该能够：• 区分双膦酸盐与其他药物的起效和终止用于预防和治疗骨质疏松症的药物以及这如何影响“药物假期”的选择。• 了解临床实践指南在护理个体患者方面的局限性以及交互式视频会议如何帮助做出决策。