Bahl Sachin, Coates Penelope S, Greenspan Susan L
Division of Endocrinology, Department of Medicine, University of Pittsburgh Medical Center, Shadyside Hospital, Pittsburgh, PA 15213, USA.
Osteoporos Int. 2003 Nov;14(11):884-8. doi: 10.1007/s00198-003-1492-2. Epub 2003 Oct 16.
To determine if physicians have improved the recognition and treatment of osteoporosis in patients with an acute hip fracture, we performed a retrospective analysis of discharge data from 1995 and 2000 at the University of Pittsburgh Medical Center, a large tertiary care, academic institution. We examined patients admitted with an acute hip fracture in 1995 and 2000 and age- and sex-matched patients admitted with community acquired pneumonia in 2000. Outcomes included age, gender, race, discharge diagnoses (from ICD-9 codes) and discharge medications (from discharge summaries) in all patients. There were 136 acute hip fracture patients (mean age 73+/-18 years) in 1995, 117 acute hip fracture patients (mean age 76+/-16 years) in 2000 and 116 patients with community-acquired pneumonia (mean age 78+/-7 years). Patients admitted in 2000 with an acute hip fracture were more likely to be diagnosed with osteoporosis (18% vs. 4%, P<0.02), more likely to be discharged on calcium (17% vs. 7%, P<0.02) and more likely to be discharged on antiresorptive therapy (15% vs. 2%, P<0.001) than those admitted in 1995. Moreover, patients admitted with community-acquired pneumonia were just as likely to receive calcium, vitamin D or antiresorptive agents at the time of discharge as those with an acute hip fracture in 2000. Patients with a diagnosis of osteoporosis in 2000 were older and more likely to receive antiresorptive agents than those without a diagnosis (29% vs. 11%, P<0.05). None of the patients received a bone mineral density examination while in the hospital. Although there was an improvement in the management of osteoporosis after an acute hip fracture from 1995 to 2000, there was no difference in management of patients with hip fracture versus pneumonia in the year 2000. However, patients with a "diagnosis" of osteoporosis in 2000 were more likely to be discharged on appropriate therapeutic options. We conclude that although we have improved our care of osteoporosis for elderly in general from 1995 to 2000, patients with an acute hip fracture are not receiving any additional treatment unless they have a diagnosis of osteoporosis. Further studies are needed to determine which factors are needed to target patients for appropriate diagnosis and treatment.
为了确定医生对急性髋部骨折患者骨质疏松症的识别和治疗是否有所改善，我们对匹兹堡大学医学中心（一家大型三级医疗学术机构）1995年和2000年的出院数据进行了回顾性分析。我们研究了1995年和2000年因急性髋部骨折入院的患者以及2000年因社区获得性肺炎入院且年龄和性别匹配的患者。所有患者的结局指标包括年龄、性别、种族、出院诊断（根据ICD - 9编码）和出院用药（根据出院小结）。1995年有136例急性髋部骨折患者（平均年龄73±18岁），2000年有117例急性髋部骨折患者（平均年龄76±16岁），以及116例社区获得性肺炎患者（平均年龄78±7岁）。与1995年入院的急性髋部骨折患者相比，2000年入院的急性髋部骨折患者更有可能被诊断为骨质疏松症（18%对4%，P<0.02），更有可能出院时服用钙剂（17%对7%，P<0.02），也更有可能出院时接受抗吸收治疗（15%对2%，P<0.001）。此外，2000年因社区获得性肺炎入院的患者出院时接受钙剂、维生素D或抗吸收药物治疗的可能性与同年因急性髋部骨折入院的患者相同。2000年被诊断为骨质疏松症的患者比未被诊断者年龄更大，且更有可能接受抗吸收药物治疗（29%对11%，P<0.05）。所有患者住院期间均未接受骨密度检查。尽管从1995年到2000年急性髋部骨折后骨质疏松症的管理有所改善，但2000年髋部骨折患者与肺炎患者的管理并无差异。然而，2000年被“诊断”为骨质疏松症的患者更有可能出院时接受适当的治疗方案。我们得出结论，虽然从1995年到2000年我们总体上改善了对老年人骨质疏松症的治疗，但急性髋部骨折患者除非被诊断为骨质疏松症，否则不会接受任何额外治疗。需要进一步研究以确定针对哪些因素来对患者进行适当诊断和治疗。
