Rozenberg S, Lefever A, Kroll M, Vandromme J, Paesmans M, Ham H
Interdisciplinary Group on Osteoporosis, Free Universities of Brussels (VUB-ULB), St Peter Hospital, Belgium.
Maturitas. 1999 May 31;32(1):19-24. doi: 10.1016/s0378-5122(99)00002-x.
The present report assesses, among Belgian gynecologists, the effect of age and bone mineral density on osteoporosis prescription strategy in postmenopausal women.
Charts of postmenopausal women were summarized. We constructed cases by modifying some parameters. Ten years of age were added or subtracted to the real age of the patient. The bone mineral density (BMD) result was also modified (three levels: normal BMD, osteopenia, osteoporosis). A total of 612 cases were constructed. Twelve cases were sent out of these 612 files to every Belgian gynecologist (n = 1010). For each chart the gynecologists were asked whether they would treat the patient with HRT. They were also asked whether they would prescribe other therapies than HRT and if so, which ones.
The chance to have an osteoporosis prevention or treatment prescribed increased when BMD decreased (respectively 57.4% for normal BMD, 73.1% for osteopenia cases and 89.4% for osteoporosis cases; P < 0.001). HRT was the most frequently prescribed medication (67% of the cases), but its prescription rate does not reflect only osteoporosis prevention. Nevertheless, for similar cases with osteopenia, the HRT prescription rate increased by a factor 1.25 and for similar cases with osteoporosis, HRT prescription rate increased by a factor 1.39. Calcium was the 2nd most frequent prescribed regimen. It was prescribed in 17% of the cases. A 3.4-fold increase for osteopenia cases and 7.6-fold increase for osteoporosis cases was observed, compared to women with normal BMD. When calcium was prescribed, it was in association with HRT in 64% of the osteopenia cases and in 76% of osteoporosis cases. Other drugs were less often prescribed. For the "younger age group", that is, with a mean age of 55 years, a prescription rate of 82.9% for any osteoporosis regimen was reached, whereas in the age group that was 10 years older a 20% lower prescription rate was reached (62.6%, P < 0.001). This was mostly due to a decrease in HRT prescription.
Prescription of medication known to reduce osteoporosis occurred more often in cases with low BMD. In the older patients with osteoporosis, gynecologists prescribed HRT less frequently. This was not compensated by a higher prescription rate of other medication.
本报告评估了在比利时妇科医生中，年龄和骨矿物质密度对绝经后妇女骨质疏松症处方策略的影响。
总结了绝经后妇女的病历。我们通过修改一些参数构建病例。在患者的实际年龄基础上加减10岁。骨矿物质密度（BMD）结果也进行了修改（三个水平：正常BMD、骨量减少、骨质疏松症）。总共构建了612个病例。从这612份病历中向每位比利时妇科医生发送12份病例（n = 1010）。对于每份病历，询问妇科医生是否会用激素替代疗法（HRT）治疗患者。还询问他们是否会开HRT以外的其他疗法，如果是，是哪些疗法。
当BMD降低时，开具骨质疏松症预防或治疗处方的可能性增加（正常BMD患者中分别为57.4%，骨量减少病例中为73.1%，骨质疏松症病例中为89.4%；P < 0.001）。HRT是最常开具的药物（67%的病例），但其处方率并不仅反映骨质疏松症的预防。然而，对于骨量减少的类似病例，HRT处方率增加了1.25倍，对于骨质疏松症的类似病例，HRT处方率增加了1.39倍。钙是第二常开具的治疗方案。在17%的病例中开具。与BMD正常的女性相比，骨量减少病例中钙的开具增加了3.4倍，骨质疏松症病例中增加了7.6倍。当开具钙时，在64%的骨量减少病例和76%的骨质疏松症病例中与HRT联合使用。其他药物开具较少。对于“较年轻年龄组”，即平均年龄为55岁的组，任何骨质疏松症治疗方案的处方率达到82.9%，而在年龄大10岁的年龄组中处方率低20%（62.6%，P < 0.001）。这主要是由于HRT处方的减少。
已知可降低骨质疏松症的药物处方在BMD低的病例中更常见。在老年骨质疏松症患者中，妇科医生开具HRT的频率较低。这并未因其他药物较高的处方率而得到补偿。
