Ip T P, Lam Cindy L K, Kung Annie W C
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, People's Republic of China.
Osteoporos Int. 2004 Apr;15(4):329-34. doi: 10.1007/s00198-003-1523-z. Epub 2004 Jan 16.
Epidemiological studies have projected a vast increase in osteoporotic fractures in Asia, with the majority occurring in China. Awareness of osteoporosis among medical professionals and the pattern of management in Asia have not been explored. A total of 504 doctors in Hong Kong, China with their self-reported practice likely to receive clients with or at risk of osteoporosis were invited to complete a postal questionnaire on the diagnosis and management of their osteoporotic patients. In all, 204 questionnaires were returned, with a response rate of 41%. Only 76% of the respondents reported treating osteoporosis patients in their practice. Ninety-one percent believed that osteoporosis was under-diagnosed. The asymptomatic nature of the disease (66%), inaccessibility (45%) and high cost (54%) of the diagnostic tools were considered major reasons for under-diagnosis. DXA was employed for diagnosis by only 53% of the doctors. Peripheral machines such as ultrasound and quantitative computed tomography were used by 35% of the responders as the only diagnostic tool, especially among clinic-based doctors (clinic-based physicians 47%, hospital-based physicians 17%; P<0.001). Thirty-three percent of the surveyed doctors were unaware of published guidelines for bone mineral density (BMD) measurements. Concerning treatment goals, 82% considered prevention of future fractures and 66% believed improvement in the quality of life of patients as critical or highly important, whereas only about half of the doctors thought that increase in BMD was important. On the other hand, 60% of the doctors considered the cost of therapy a critical or highly important element in the management of osteoporosis. This study showed that physicians in Hong Kong were aware of osteoporosis, though the disease was still under-diagnosed due to inaccessibility and high cost of the diagnostic tools and therapeutic agents. These findings stress the importance of expanding efforts to increase knowledge and awareness among health care providers and also provide future directions for developing strategies for managing osteoporosis in developing Asian regions.
流行病学研究预测，亚洲骨质疏松性骨折的数量将大幅增加，其中大多数发生在中国。然而，亚洲医学专业人员对骨质疏松症的认知以及管理模式尚未得到研究。在中国香港，共有504名自报其业务可能会接待骨质疏松症患者或有骨质疏松症风险患者的医生受邀填写一份关于其骨质疏松症患者诊断和管理的邮政调查问卷。总共收回了204份问卷，回复率为41%。只有76%的受访者报告在其业务中治疗骨质疏松症患者。91%的人认为骨质疏松症诊断不足。该疾病的无症状性质（66%）、诊断工具难以获取（45%）和成本高昂（54%）被认为是诊断不足的主要原因。只有53%的医生使用双能X线吸收法（DXA）进行诊断。35%的受访者将超声和定量计算机断层扫描等外周设备作为唯一的诊断工具，尤其是在基层医生中（基层医生占47%，医院医生占17%；P<0.001）。33%的受访医生不知道已发布的骨密度（BMD）测量指南。关于治疗目标，82%的人认为预防未来骨折至关重要，66%的人认为改善患者生活质量至关重要或非常重要，而只有约一半的医生认为增加骨密度很重要。另一方面，60%的医生认为治疗费用是骨质疏松症管理中的一个关键或非常重要的因素。这项研究表明，香港的医生了解骨质疏松症，尽管由于诊断工具和治疗药物难以获取以及成本高昂，该疾病仍诊断不足。这些发现强调了加大努力提高医疗保健提供者知识和认知的重要性，也为在亚洲发展中地区制定骨质疏松症管理策略提供了未来方向。
