Solomon D H, Levin E, Helfgott S M
Division of Rheumatology, Allergy, Immunology, Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Boston, Massachusetts, USA.
J Rheumatol. 2000 Jun;27(6):1496-500.
We examined the medications used by women before and after bone densitometry to determine whether patient or physician factors were associated with appropriate osteoporosis therapy.
Appropriate osteoporosis treatment was defined as alendronate, etidronate, calcitonin, or hormone replacement therapy (HRT) for women with any bone mineral density (BMD) t score < -2.5 or no osteoporosis therapy, except HRT, for women with t scores > -1.0. We observed a cohort of women who underwent bone densitometry at one outpatient osteoporosis clinic. Medical history, medication use, and demographic data were collected at the time of bone densitometry. A followup questionnaire assessed the medication use patterns since bone densitometry and attitudes about osteoporosis therapy.
We recruited 553 women who underwent bone densitometry in 1996. Their mean age was 62 years and 95% were postmenopausal. Prior to bone density scans, 27% of patients used HRT, 15% used bisphosphonates, and 6% used calcitonin. Scan results and surveys revealed that 40% of patients had BMD below a t score of -2.5 at any site. Of women with osteoporosis 78% reported taking an appropriate medication after their scans. Patients most likely to receive appropriate treatment were those who understood their bone densitometry results (odds ratio, OR, 2.5; 95% confidence interval, CI, 1.3 to 4.8) and patients who were taking an osteoporosis medication (OR 1.9; 95% CI 1.0 to 3.6). Neither the specialty of the referring physician nor patients' medical history was associated with use of appropriate osteoporosis therapy.
Of women with osteoporosis who underwent bone densitometry 78% received appropriate therapy after this test. Patient factors were associated with the likelihood that they received appropriate therapy, suggesting that strategies aimed at educating patients may improve the use of osteoporosis medications.
我们研究了女性在骨密度测定前后所使用的药物，以确定患者或医生因素是否与适当的骨质疏松症治疗相关。
适当的骨质疏松症治疗定义为：对于任何骨矿物质密度（BMD）t值＜ -2.5的女性，给予阿仑膦酸盐、依替膦酸盐、降钙素或激素替代疗法（HRT）；对于t值＞ -1.0的女性，除HRT外不进行骨质疏松症治疗。我们观察了一组在一家门诊骨质疏松症诊所接受骨密度测定的女性。在进行骨密度测定时收集病史、用药情况和人口统计学数据。一份随访问卷评估了自骨密度测定以来的用药模式以及对骨质疏松症治疗的态度。
我们招募了1996年接受骨密度测定的553名女性。她们的平均年龄为62岁，95%为绝经后女性。在进行骨密度扫描之前，27%的患者使用HRT，15%使用双膦酸盐，6%使用降钙素。扫描结果和调查显示，40%的患者在任何部位的BMD低于t值 -2.5。在患有骨质疏松症的女性中，78%报告在扫描后服用了适当的药物。最有可能接受适当治疗的患者是那些理解其骨密度测定结果的患者（优势比，OR，2.5；95%置信区间，CI，1.3至4.8）以及正在服用骨质疏松症药物的患者（OR 1.9；95% CI 1.0至3.6）。转诊医生的专业和患者的病史均与适当的骨质疏松症治疗的使用无关。
在接受骨密度测定的患有骨质疏松症的女性中，78%在该测试后接受了适当的治疗。患者因素与她们接受适当治疗的可能性相关，这表明旨在教育患者的策略可能会改善骨质疏松症药物的使用。
