Colón-Emeric C, Yballe L, Sloane R, Pieper C F, Lyles K W
Duke University Medical Center, Durham VAMC Dept of Geriatrics Research and Education Clinical Center, North Carolina 27705, USA.
J Am Geriatr Soc. 2000 Oct;48(10):1261-3. doi: 10.1111/j.1532-5415.2000.tb02599.x.
To develop recommendations for the evaluation and the treatment of men with osteoporotic hip fracture from expert publications in the field of male osteoporosis, and to define the current practice patterns in a tertiary care VA Medical Center in Durham, North Carolina.
Survey research; a retrospective cohort study.
Tertiary care VA Medical Center in Durham, North Carolina.
(1) US physicians who published on the subject of male osteoporosis in the peer-reviewed literature between 1993 and 1997 identified by MEDLINE database search. (2) All 119 men admitted to the Durham VA Medical Center with ICD9 code for hip fracture between 1994 and 1998.
(1) Osteoporosis evaluation and treatment recommendations of published physicians obtained by survey instrument. (2) Actual osteoporosis evaluation completed and therapy prescribed during index hospitalization in a cohort of men with hip fractures, determined by chart and database review.
(1) Forty-three physician-researchers were surveyed with an 84% response rate. For an osteoporosis evaluation, 89% of respondents recommended measuring serum testosterone, 85% serum calcium, 75% 25-OH vitamin D levels, 73% myeloma screen, and 61% serum thyroid-stimulating hormone (TSH). Dual Energy X-ray Absorptiometry would be obtained by 92%. More than 70% recommended calcium, vitamin D, and bisphosphonates for men with a normal metabolic evaluation, and 60% suggested weight-bearing exercise. (2) In the cohort of men admitted with hip fractures, 50% had a serum calcium level and 3% had a serum TSH level measured. Vitamin D was prescribed to 25% of patients in the form of a multivitamin, and 4% received calcium. There was no bisphosphonate, testosterone, or calcitonin use.
Physicians who have published on osteoporosis recommended metabolic evaluation and osteoporosis therapy after hip fracture. Only minimal evaluation and treatment occurred in a cohort of men with osteoporotic hip fractures.
根据男性骨质疏松领域的专家文献制定评估和治疗男性骨质疏松性髋部骨折的建议，并确定北卡罗来纳州达勒姆一家三级医疗退伍军人事务医疗中心的当前实践模式。
调查研究；回顾性队列研究。
北卡罗来纳州达勒姆的三级医疗退伍军人事务医疗中心。
（1）通过医学文献数据库检索确定的1993年至1997年间在同行评审文献中发表过男性骨质疏松相关主题的美国医生。（2）1994年至1998年间因髋部骨折被收入达勒姆退伍军人事务医疗中心且国际疾病分类第九版（ICD9）编码为此病的所有119名男性。
（1）通过调查问卷获取已发表医生的骨质疏松评估和治疗建议。（2）通过病历和数据库审查确定髋部骨折男性队列在本次住院期间实际完成的骨质疏松评估及开具的治疗方案。
（1）对43名医生 - 研究人员进行了调查，回复率为84%。对于骨质疏松评估，89%的受访者建议检测血清睾酮，85%建议检测血清钙，75%建议检测25 - 羟基维生素D水平，73%建议进行骨髓瘤筛查，61%建议检测血清促甲状腺激素（TSH）。92%的受访者会采用双能X线吸收法。超过70%的受访者建议对代谢评估正常的男性补充钙、维生素D和双膦酸盐，60%建议进行负重锻炼。（2）在髋部骨折入院的男性队列中，50%检测了血清钙水平，3%检测了血清TSH水平。25%的患者以复合维生素形式补充了维生素D，4%的患者补充了钙。未使用双膦酸盐、睾酮或降钙素。
发表过骨质疏松相关文章的医生建议在髋部骨折后进行代谢评估和骨质疏松治疗。在骨质疏松性髋部骨折男性队列中，实际进行的评估和治疗极少。
