Gunter Margaret J, Beaton Sarah J, Brenneman Susan K, Chen Ya-Ting, Abbott Thomas A, Gleeson Jeremy M
Lovelace Clinic Foundation, 2309 Renard Place SE, Suite 103, Albuquerque, NM 87106, USA.
Dis Manag. 2003 Summer;6(2):83-91. doi: 10.1089/109350703321908469.
This study describes the pattern of evaluation and management of osteoporosis in women aged 50 and older following an osteoporosis-related fracture, conducted as a retrospective cohort study using the administrative claims database of a managed care organization. Subjects were women, aged 50 years and older, with at least one osteoporosis-related fracture in the years 1996-1998 who were continuously enrolled in the system's health plan for at least 6 months prior to and post-fracture. Bone mineral density (BMD) testing, diagnosis of osteoporosis, and treatment with any Food and Drug Administration-approved medication for osteoporosis were identified using CPT, ICD-9, and National Drug Codes for the 6-month post-fracture period. There were 658 women with an osteoporosis-related fracture: 189 (29%) hip fractures, 226 (34%) wrist fractures, 127 (19%) vertebral fractures, and 116 (18%) rib fractures. In the post-fracture period, 46 (7%) underwent BMD testing, 153 (23%) had a diagnosis of osteoporosis, and 220 (31%) were treated with a medication approved for the prevention or treatment of osteoporosis. Of the 220 women with medication claims, 124 (56%) were for estrogen, and 96 (44%) were for other antiresorptive agents. Of the 507 women who did not have medication claims during the 6 months prior to the fracture, only 17% had new fills after the fracture. Management of osteoporosis in women aged 50 and older with fractures was inadequate, despite the high risk of subsequent fractures and recommendations that osteoporosis be the presumptive diagnosis. Significant opportunity exists for improvement in assuring post-fracture followup care.
本研究描述了50岁及以上女性骨质疏松性骨折后骨质疏松的评估和管理模式，该研究作为一项回顾性队列研究，使用了一家管理式医疗组织的行政索赔数据库。研究对象为50岁及以上的女性，她们在1996 - 1998年期间至少发生过一次骨质疏松性骨折，且在骨折前后至少连续6个月参加了该系统的健康计划。通过使用CPT、ICD - 9和国家药品代码，确定了骨折后6个月内的骨密度（BMD）检测、骨质疏松症诊断以及使用任何美国食品药品监督管理局批准的骨质疏松症药物进行的治疗。共有658名患有骨质疏松性骨折的女性：189例（29%）为髋部骨折，226例（34%）为腕部骨折，127例（19%）为椎体骨折，116例（18%）为肋骨骨折。在骨折后期间，46例（7%）接受了BMD检测，153例（23%）被诊断为骨质疏松症，220例（31%）接受了批准用于预防或治疗骨质疏松症的药物治疗。在220例有药物索赔的女性中，124例（56%）使用了雌激素，96例（44%）使用了其他抗吸收剂。在骨折前6个月没有药物索赔的507名女性中，只有17%在骨折后有新的药物填充。尽管后续骨折风险高且建议将骨质疏松症作为推定诊断，但50岁及以上骨折女性的骨质疏松症管理仍不充分。在确保骨折后随访护理方面存在显著的改进机会。
