Gehlbach S H, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood J R
University of Massachusetts at Amherst School of Public Health & Health Sciences, USA.
Osteoporos Int. 2000;11(7):577-82. doi: 10.1007/s001980070078.
Osteoporosis-related vertebral fractures have important health consequences for older individuals, including disability and increased mortality. Because these fractures can be prevented with appropriate medications, recognition and treatment of high-risk patients is warranted. A cross-sectional survey was carried out in a large, regional hospital in New England to examine the frequency with which vertebral fractures are identified and treated by clinicians in a population of hospitalized older women who have radiographic evidence of fractures. The study population consisted of 934 women aged 60 years and older who were hospitalized between October 1, 1995 and March 31, 1997, and who had a chest radiograph obtained. Vertebral fractures in the thoracic region were identified by two radiologists. Discharge diagnoses, medical record notes and radiology reports were compared with the results of the radiologists' readings to determine the frequency with which fractures were identified and appropriate, osteoporosis-preventing medications prescribed. Moderate or severe vertebral fractures were identified for 132 (14.1%) study subjects, but only 17 (1.8%) of the 934 participants had a discharge diagnosis of vertebral fracture. Of these 132, only 17% had fracture noted in the medical record or discharge summary; 50% of contemporaneous radiology reports identified a fracture as present; and 23% of the time it was found in the radiologist's summary impression. Only 18% of medical records indicated that fracture patients had been prescribed calcium, vitamin D, estrogen replacement or an antiresorptive agent. Relatively few hospitalized older women with radiographically demonstrated vertebral fractures were thus identified or treated by clinicians, suggesting a need for improved recognition.
骨质疏松相关的椎体骨折对老年人具有重要的健康影响，包括残疾和死亡率增加。由于这些骨折可以通过适当的药物预防，因此识别和治疗高危患者是必要的。在新英格兰的一家大型地区医院进行了一项横断面调查，以检查临床医生在有骨折影像学证据的住院老年女性人群中识别和治疗椎体骨折的频率。研究人群包括934名60岁及以上的女性，她们在1995年10月1日至1997年3月31日期间住院，并进行了胸部X光检查。两名放射科医生识别出胸椎区域的椎体骨折。将出院诊断、病历记录和放射学报告与放射科医生的读片结果进行比较，以确定骨折被识别的频率以及是否开出了适当的预防骨质疏松的药物。132名（14.1%）研究对象被识别出有中度或重度椎体骨折，但在934名参与者中，只有17名（1.8%）有椎体骨折的出院诊断。在这132名患者中，只有17%在病历或出院小结中记录了骨折；50%的同期放射学报告识别出存在骨折；23%的情况是在放射科医生的总结印象中发现的。只有18%的病历表明骨折患者被开了钙、维生素D、雌激素替代药物或抗吸收剂。因此，临床上识别或治疗的有影像学证据显示椎体骨折的住院老年女性相对较少，这表明需要提高识别能力。
