Wei Gina S, Jackson Jeffrey L, O'Malley Patrick G
VA Medical Center in Washington, DC, USA.
J Am Med Womens Assoc (1972). 2003 Spring;58(2):99-104.
The National Osteoporosis Foundation (NOF) practice guideline provides explicit recommendations for postmenopausal osteoporosis risk assessment and management. This study evaluated primary care adherence to the recommendations and factors associated with such adherence.
Postmenopausal women 40 years old and older were sampled in the primary care clinic of a US tertiary hospital. We received 469 completed questionnaires that measured the respondent's demographics and osteoporosis risk factors; current and historical osteoporosis counseling, testing, and treatment; and whether or not she had a primary care clinician. Based on information provided, we determined whether each woman was receiving care that followed the NOF guideline. Univariate and multivariate analyses identified factors associated with guideline adherence.
Mean age was 69 years; 53% were white and 38% black; 15% had prior fractures. Using NOF criteria, 19.8 % were at moderate risk and 80.2 % were at high risk for osteoporosis. Overall, 57.6% (95% confidence interval 53.1, 62.1) of patients received risk management in accordance with the NOF guideline. The adherence rate was higher in the high-risk group (60.9% v 44.1%, p=.003), in those who had primary care clinicians (62.0% v 43.5%, p=.006), and in nonblack patients (white v black 67.1% v 43.0%, p<.001; other v black 65.0% v 43.0%, p=.012). These associations remained statistically significant after multivariate adjustments. Adherence was not associated with the sex of the primary care clinician.
More than half of postmenopausal women in our study were receiving osteoporosis risk management that followed the NOF practice guideline. Those who were at higher risk, who were not black, or who had primary care clinicians were more likely to receive care in accordance with the NOF guideline, regardless of the sex of the clinician.
美国国家骨质疏松基金会（NOF）的实践指南为绝经后骨质疏松症的风险评估和管理提供了明确的建议。本研究评估了初级保健机构对这些建议的遵循情况以及与这种遵循情况相关的因素。
在美国一家三级医院的初级保健诊所对40岁及以上的绝经后女性进行抽样。我们收到了469份完整的问卷，这些问卷测量了受访者的人口统计学信息和骨质疏松症风险因素；当前和既往的骨质疏松症咨询、检测和治疗情况；以及她是否有初级保健医生。根据所提供的信息，我们确定每位女性是否接受了符合NOF指南的治疗。单因素和多因素分析确定了与指南遵循情况相关的因素。
平均年龄为69岁；53%为白人，38%为黑人；15%有既往骨折史。根据NOF标准，19.8%处于中度风险，80.2%处于骨质疏松症的高风险。总体而言，57.6%（95%置信区间53.1, 62.1）的患者接受了符合NOF指南的风险管理。高风险组的遵循率更高（60.9%对44.1%，p = 0.003），有初级保健医生的患者遵循率更高（62.0%对43.5%，p = 0.006），非黑人患者遵循率更高（白人对黑人6
