McLellan Alastair R, Gallacher Stephen J, Fraser Mayrine, McQuillian Carol
Western Infirmary, Glasgow, UK.
Osteoporos Int. 2003 Dec;14(12):1028-34. doi: 10.1007/s00198-003-1507-z. Epub 2003 Nov 5.
Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow.
An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures.
During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service's osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine.
The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.
骨折治疗往往是骨质疏松症临床管理的首次契机；然而，许多患者在骨折后并未接受任何评估。在苏格兰格拉斯哥，接受骨密度（BMD）检测的骨折患者不到10%。为了通过提供常规评估以及在必要时对骨折后的骨质疏松症患者进行治疗，从而更好地满足骨折患者的需求，在格拉斯哥的两个独立的国民医疗服务信托机构中设计并实施了一项新型服务（骨折联络服务）。
与骨科外科医生和初级保健医生合作，为50岁及以上的骨折男女制定了商定的护理标准。骨折联络服务负责骨折病例的发现、评估和进行诊断评估（包括轴向双能X线吸收法），并为骨质疏松性骨折的二级预防提出具体的治疗建议。
在运营的前18个月中，骨折联络服务的骨质疏松症专科护士接待了4600多名髋部、腕部、肱骨、踝部、足部、手部及其他部位骨折的患者。这些患者中近四分之三被考虑进行骨密度检测；约20%无需进行骨密度检测的患者被建议接受治疗。总体而言，接受骨密度检测的患者中，82.3%在髋部或脊柱处被发现患有骨量减少或骨质疏松症。
骨折联络服务已成功识别并评估了大多数骨折患者。只有那些拒绝的患者未得到评估。该项目的最终成功将通过这些患者随后的骨折经历来衡量，但在骨折患者中诊断和治疗低骨密度方面已明显取得了进展。
