Buist Diana S M, LaCroix Andrea Z, Brenneman Susan K, Abbott Thomas
Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA.
J Am Geriatr Soc. 2004 Jul;52(7):1130-7. doi: 10.1111/j.1532-5415.2004.52311.x.
To describe differences in osteoporosis risk factors and rates of fracture and antiresorptive therapy use in women who did and did not participate in an osteoporosis screening program.
Group Health Cooperative, a health maintenance organization in western Washington state.
A total of 9,268 women (aged 60-80) who were not using any antiresorptive therapy were invited to participate in an osteoporosis screening program. This study compares the 35% who participated with the 65% who did not.
This observational cohort study of women invited to participate in a randomized, controlled trial of an osteoporosis screening program provided all participants with personalized feedback on their risk of osteoporosis. Some participants also received bone density testing. Automated administrative data were used to examine differences between participants and nonparticipants in fracture outcomes and medication initiation before and after invitation.
Baseline fracture rates did not differ between participants and nonparticipants. After age adjustment, nonparticipants had a higher hip fracture rate (14.1 vs 8.3 per 1,000) and a lower rate of initiating any antiresorptive therapy (10.3 vs 17.9 per 100) than participants after an average of 28 to 29 months of follow-up.
Participants had reduced hip fracture rates and increased initiation of antiresorptive therapy compared with nonparticipants. It was not possible to determine whether participating in the screening program, unmeasured confounding, or selection bias accounted for differences in hip fracture or therapy initiation rates. These results suggest that women who do not participate in osteoporosis screening should be pursued to identify individuals who could benefit from primary and secondary osteoporosis prevention.
描述参与和未参与骨质疏松症筛查项目的女性在骨质疏松症风险因素、骨折发生率及抗吸收治疗使用情况方面的差异。
华盛顿州西部的一家健康维护组织——Group Health Cooperative。
共有9268名未使用任何抗吸收治疗的60 - 80岁女性被邀请参加骨质疏松症筛查项目。本研究将参与项目的35%的女性与未参与的65%的女性进行比较。
这项针对受邀参加骨质疏松症筛查项目随机对照试验的女性的观察性队列研究，为所有参与者提供了关于其骨质疏松症风险的个性化反馈。部分参与者还接受了骨密度检测。利用自动化管理数据来检查受邀前后参与者与非参与者在骨折结局和药物起始使用方面的差异。
参与者与非参与者的基线骨折发生率无差异。经过年龄调整后，在平均28至29个月的随访期后，非参与者的髋部骨折发生率更高（每1000人中有14.1例 vs 8.3例），且开始使用任何抗吸收治疗的比例更低（每100人中有10.3例 vs 17.9例）。
与非参与者相比，参与者的髋部骨折发生率降低，抗吸收治疗的起始使用增加。无法确定是参与筛查项目、未测量的混杂因素还是选择偏倚导致了髋部骨折或治疗起始率的差异。这些结果表明，应追踪未参与骨质疏松症筛查的女性，以识别那些可从原发性和继发性骨质疏松症预防中获益的个体。
