Fitt N S, Mitchell S L, Cranney A, Gulenchyn K, Huang M, Tugwell P
Division of Geriatrics, Ottawa Hospital and University of Ottawa, Ottawa, Ont.
CMAJ. 2001 Mar 20;164(6):777-81.
Measurement of bone mineral density is widely used to diagnose osteoporosis. The objectives of this study are to determine how bone densitometry affects subsequent treatment of osteopenia and osteoporosis with either hormone replacement therapy or bisphosphonates and to examine clinical factors associated with starting either therapy after bone densitometry.
We conducted a prospective study involving women over 50 years of age who were referred to a tertiary care hospital for the first time to undergo bone density measurement using dual-energy x-ray absorptiometry (DXA). Baseline clinical data were collected through face-to-face interviews before the test. Subsequently, the scans were reviewed and categorized as showing no bone loss, osteopenia or osteoporosis, based on World Health Organization criteria. Three months after DXA, subjects were contacted by telephone to determine their understanding of the test results and any new treatments started or recommended since the scan.
Of 383 women recruited at the time of their DXA, 335 (87.5%) completed the 3-month follow-up. Among those reached at follow-up, DXA results showed no bone loss in 119 (35.5%), osteopenia in 137 (40.9%) and osteoporosis in 79 (23.6%). The proportion of subjects with osteoporosis receiving either hormone replacement therapy or bisphosphonate therapy was 15.2% before the test, increasing to 63.3% after the scan. The following factors were independently associated with the initiation of either therapy: actual DXA result showing osteoporosis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.7-30.3), compared with a normal scan; subjects' perception that their scan showed bone loss (osteopenia, or osteoporosis) (OR 13.5; 95% CI 4.0-45.5) or that they were unclear about the results (OR 5.4; 95% CI 1.6-18.8), compared with the perception that the results were normal; and discussion of the DXA results with a physician (OR 5.5; 95% CI 1.9-16.0).
The proportion of women with osteoporosis receiving hormone replacement therapy or bisphosphonate therapy increases after diagnosis with densitometry. However, communication by physicians so that patients understand their test results is a critical component in the initiation of therapy after bone densitometry.
骨密度测量被广泛用于诊断骨质疏松症。本研究的目的是确定骨密度测定如何影响随后采用激素替代疗法或双膦酸盐对骨质减少和骨质疏松症的治疗，并检查骨密度测定后开始这两种治疗的相关临床因素。
我们进行了一项前瞻性研究，纳入了首次被转诊至三级护理医院，使用双能X线吸收法（DXA）进行骨密度测量的50岁以上女性。在检查前通过面对面访谈收集基线临床数据。随后，根据世界卫生组织标准，对扫描结果进行复查并分类为无骨质流失、骨质减少或骨质疏松。DXA检查三个月后，通过电话联系受试者，以确定她们对检查结果的理解，以及自扫描以来开始或推荐的任何新治疗。
在进行DXA检查时招募的383名女性中，335名（87.5%）完成了3个月的随访。在随访到的受试者中，DXA结果显示无骨质流失的有119名（35.5%），骨质减少的有137名（40.9%），骨质疏松的有79名（23.6%）。在检查前，接受激素替代疗法或双膦酸盐治疗的骨质疏松症患者比例为15.2%，扫描后增至63.3%。以下因素与开始这两种治疗独立相关：实际DXA结果显示为骨质疏松（比值比[OR]7.2；95%置信区间[CI]1.7 - 30.3），与正常扫描相比；受试者认为其扫描显示骨质流失（骨质减少或骨质疏松）（OR 13.5；95% CI 4.0 - 45.5）或对结果不清楚（OR 5.4；95% CI 1.6 - 18.8），与认为结果正常相比；以及与医生讨论DXA结果（OR 5.5；95% CI 1.9 - 16.0）。
骨密度测定诊断后，接受激素替代疗法或双膦酸盐治疗 的骨质疏松症女性比例增加。然而，医生进行沟通以使患者理解其检查结果是骨密度测定后开始治疗的关键组成部分。
