Jaglal S B, McIsaac W J, Hawker G, Jaakkimainen L, Cadarette S M, Chan B T
Department of Physical Therapy, University of Toronto.
CMAJ. 2000 Oct 31;163(9):1139-43.
There is ongoing controversy about who should be referred for bone mineral density (BMD) testing to estimate fracture risk and diagnose osteoporosis. The purpose of this study was to examine patterns of use of BMD testing in Ontario between 1992 and 1998.
All physician claims from the Ontario Health Insurance Plan (OHIP) claims database for BMD testing between Jan. 1, 1992, and Dec. 31, 1998, were categorized by age and sex of the patient and the specialty of the physician who ordered the test. Time trends and regional rate variation analyses were also performed. To examine the prevalence of repeat testing, an inception cohort of women who had a BMD test in 1996 was followed for 2 years from the date of first test.
From 1992 to 1998 the number of BMD tests performed per year in women increased from 34,402 to 230,936 and in men from 2,162 to 13,579. In 1998 most tests were being ordered by family physicians (80.2% in 1998 v. 52.1% in 1992). Approximately 1 in 7 women aged 55-69 years had BMD tests done in 1998. Within a 2-year period 29.3% of these women had the test repeated; the mean time between tests was 16 months. Regional rate variation analyses of BMD tests performed in 1996-1998 indicated a 235-fold variation in BMD test rates across counties in Ontario, with a range from 0.2 to 47.1 per 1000 women in the population.
The number of BMD tests performed each year in Ontario is increasing rapidly. However, the significant variation between rates of testing in different regions indicates that the diffusion of this technology may not be taking place according to population need.
关于应该将哪些人转诊去进行骨密度（BMD）检测以评估骨折风险和诊断骨质疏松症，目前仍存在争议。本研究的目的是调查1992年至1998年安大略省骨密度检测的使用模式。
对安大略省医疗保险计划（OHIP）索赔数据库中1992年1月1日至1998年12月31日期间所有医生开具的骨密度检测索赔，按照患者的年龄和性别以及开具检测医嘱的医生专业进行分类。还进行了时间趋势分析和地区率差异分析。为了调查重复检测的患病率，对1996年进行骨密度检测的一组女性起始队列从首次检测日期开始随访2年。
1992年至1998年，每年女性进行骨密度检测的数量从34,402例增加到230,936例，男性从2,162例增加到13,579例。1998年，大多数检测是由家庭医生开具的（1998年为80.2%，而1992年为52.1%）。1998年，55至69岁的女性中约七分之一进行了骨密度检测。在两年内，这些女性中有29.3%进行了重复检测；两次检测之间的平均时间为16个月。对1996 - 1998年进行的骨密度检测的地区率差异分析表明，安大略省各县之间骨密度检测率相差235倍，每1000名女性中的检测率范围为0.2至47.1。
安大略省每年进行的骨密度检测数量正在迅速增加。然而，不同地区检测率之间的显著差异表明，这项技术的推广可能并非根据人群需求进行。
