Hajcsar E E, Hawker G, Bogoch E R
Queen's University, Kingston, Ont.
CMAJ. 2000 Oct 3;163(7):819-22.
Many patients who have undiagnosed osteoporosis and a recent fragility fracture present to fracture clinics in Canadian hospitals, where the focus of management is on fracture care. The rate of diagnosis and treatment of osteoporosis in this patient group is unknown.
Patients who presented with fractures at sites consistent with fragility-type fractures were identified through a retrospective chart review of fracture clinic visits in 3 Ontario community hospitals in selected weeks in February and November 1996 and August and May 1997. These patients were contacted by mail and telephone follow-up to obtain consent to participate in a telephone interview. Patients were excluded if the index fracture had been traumatic, if they were younger than 18 years, or if they had medical conditions known to be associated with secondary bone loss. Eligible patients were questioned about their history of prior fractures, diagnosis of osteoporosis, and investigation and treatment of osteoporosis before or after the index fracture.
Among 2694 fracture clinic visits, we identified 228 patients (8.4%) with fragility-type fractures. Of the 228, 128 (56.1%) were contacted and agreed to participate in an interview about 1 year from the date of the index fracture. Of the 128 patients, 108 (83 postmenopausal and 13 premenopausal women and 12 men) were confirmed as eligible. Of the 108, 43 had experienced 53 fractures in addition to the index fracture in the preceding 10 years, of which 71% were of the fragility type. At interview, only 20 (18.5%) (all postmenopausal women) of the 108 patients reported that they had received a diagnosis of osteoporosis. Of the 20, 90% and 45% respectively had been advised to take calcium and vitamin D supplements; 8 (40%) were receiving hormone replacement therapy (HRT), and 8 (40%) were taking bisphosphonates. Of the 88 patients who had not received a diagnosis of osteoporosis, 4 (4.5%) were receiving HRT, none was taking bisphosphonates, and less than 20% had been advised to take supplemental calcium or vitamin D.
In a representative sample of patients at urban fracture clinics, less than 20% who presented with a fragility-type fracture had undergone investigation and adequate treatment of osteoporosis at 1-year follow-up. Since previous fracture significantly increases the risk for future fracture, this clearly is a deficiency in management. Through improved identification and treatment of patients with osteoporosis-related fractures who present to fracture clinics, there is a significant opportunity to reduce the rates of illness and death associated with this condition.
许多患有未确诊骨质疏松症且近期发生脆性骨折的患者前往加拿大医院的骨折诊所就诊，这些诊所的管理重点是骨折护理。该患者群体中骨质疏松症的诊断和治疗率尚不清楚。
通过回顾性查阅1996年2月和11月以及1997年8月和5月选定几周内安大略省3家社区医院骨折诊所就诊记录，确定那些骨折部位符合脆性骨折类型的患者。通过邮件和电话随访联系这些患者，征得他们同意参加电话访谈。如果初次骨折为创伤性骨折、患者年龄小于18岁或患有已知与继发性骨质流失相关的疾病，则将其排除。符合条件的患者被询问其既往骨折史、骨质疏松症诊断情况以及初次骨折前后骨质疏松症的检查和治疗情况。
在2694次骨折诊所就诊病例中，我们确定了228例（8.4%）脆性骨折患者。其中128例（56.1%）被联系上并同意在初次骨折日期约1年后参加访谈。在这128例患者中，108例（83例绝经后女性、13例绝经前女性和12例男性）被确认为符合条件。在这108例患者中，43例在之前10年除初次骨折外还经历了53次骨折，其中71%为脆性骨折类型。在访谈中，108例患者中只有20例（18.5%）（均为绝经后女性）报告他们已被诊断患有骨质疏松症。在这20例患者中，分别有90%和45%曾被建议补充钙和维生素D；8例（40%）接受激素替代疗法（HRT），8例（40%）服用双膦酸盐。在88例未被诊断患有骨质疏松症的患者中，4例（4.5%）接受HRT，无人服用双膦酸盐，不到20%的患者曾被建议补充钙或维生素D。
在城市骨折诊所的代表性患者样本中，出现脆性骨折的患者在1年随访时，接受骨质疏松症检查和充分治疗的不到20%。由于既往骨折会显著增加未来骨折的风险，这显然是管理上的不足。通过改进对前往骨折诊所就诊的骨质疏松症相关骨折患者的识别和治疗，有很大机会降低与此疾病相关的发病率和死亡率。
