Freedman K B, Kaplan F S, Bilker W B, Strom B L, Lowe R A
Department of Orthopaedic Surgery, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
J Bone Joint Surg Am. 2000 Aug;82(8):1063-70. doi: 10.2106/00004623-200008000-00001.
Medical treatment of women with established osteoporosis may decrease the incidence of future fractures. Postmenopausal women who have sustained a distal radial fracture have decreased bone-mineral density and nearly twice the risk of a future hip fracture. The purpose of this study was to evaluate the adequacy of diagnosis and treatment of osteoporosis in postmenopausal women following an acute fracture of the distal part of the radius.
A retrospective cohort study was performed with use of a claims database that includes more than three million patients, from thirty states, enrolled in multiple health plans. All women, fifty-five years of age or older, who sustained a distal radial fracture between July 1, 1994, and June 30, 1997, were identified in the database. Only patients with at least six months of continuous and complete medical and pharmaceutical health-care coverage from the date of the fracture were enrolled, to ensure that all health-care claims would be captured in the database. This cohort of patients was then evaluated to determine the proportion who had undergone either a diagnostic bone-density scan or treatment with any recommended medication for established osteoporosis (estrogen, a bisphosphonate, or calcitonin) within six months following the fracture.
A search of the database identified 1,162 women, fifty-five years of age or older, who had a distal radial fracture. Of these 1,162 patients, thirty-three (2.8 percent) underwent a bone-density scan and 266 (22.9 percent) were treated with at least one of the medications approved for treatment of established osteoporosis. Twenty women had both a bone-density scan and drug treatment. Therefore, only 279 (24.0 percent) of the 1,162 women who sustained a distal radial fracture underwent either diagnostic evaluation or treatment of osteoporosis. There was a significant decrease in the rate of treatment of osteoporosis with increasing patient age at the time of the fracture (p < 0.0001).
Current physician practice may be inadequate for the diagnosis and treatment of osteoporosis in postmenopausal women who have sustained a distal radial fracture.
对已确诊骨质疏松症的女性进行药物治疗可能会降低未来骨折的发生率。发生桡骨远端骨折的绝经后女性骨矿物质密度降低，未来发生髋部骨折的风险几乎增加一倍。本研究的目的是评估绝经后女性桡骨远端急性骨折后骨质疏松症的诊断和治疗是否充分。
利用一个包含来自30个州、参加多个健康计划的300多万患者的理赔数据库进行了一项回顾性队列研究。在数据库中识别出所有1994年7月1日至1997年6月30日期间发生桡骨远端骨折的55岁及以上女性。仅纳入自骨折之日起至少有6个月连续且完整的医疗和药物医疗保健覆盖的患者，以确保数据库中能获取所有医疗保健理赔信息。然后对该队列患者进行评估，以确定在骨折后6个月内接受过诊断性骨密度扫描或使用任何推荐药物（雌激素、双膦酸盐或降钙素）治疗已确诊骨质疏松症的患者比例。
对数据库进行检索，识别出1162名55岁及以上发生桡骨远端骨折的女性。在这1162名患者中，33名（2.8%）接受了骨密度扫描，266名（22.9%）接受了至少一种批准用于治疗已确诊骨质疏松症的药物治疗。20名女性既进行了骨密度扫描又接受了药物治疗。因此，在1162名发生桡骨远端骨折的女性中，只有279名（24.0%）接受了骨质疏松症的诊断评估或治疗。随着骨折时患者年龄的增加，骨质疏松症的治疗率显著下降（p < 0.0001）。
对于发生桡骨远端骨折的绝经后女性，目前医生的做法在骨质疏松症的诊断和治疗方面可能并不充分。
