Bliuc Dana, Ong Cynthia R, Eisman John A, Center Jacqueline R
Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia.
Osteoporos Int. 2005 Aug;16(8):977-82. doi: 10.1007/s00198-004-1788-x. Epub 2004 Nov 23.
Osteoporosis management is suboptimal even for high-risk people with a history of prior fracture. There is also evidence that individuals with moderate trauma fracture have a lower bone density and are at higher risk of subsequent fracture. This study aimed to define factors influencing the management of individuals at risk for osteoporosis and to examine the risk profiles of individuals with minimal and moderate trauma fractures. Consecutive fracture patients (n =218) treated in the outpatient fracture clinic in St Vincent's Hospital, Sydney, over a 15-month period (February 2002-July 2003) were interviewed. Fracture risk factors, prior investigation and treatment for osteoporosis were collected and participants were contacted after 3 months to ascertain follow-up. Risk factors for osteoporosis including family history, low dietary calcium and conditions associated with bone loss were similar between low- and moderate-trauma groups and between sexes. Even though half of participants had had a prior fracture, only 34% had a bone density scan and 16% were on anti-resorptive treatment. There was a minimal (6%) increase in the rates of investigation and treatment at the 3-month follow-up, and less in the moderate trauma group and males. Independent predictors for being investigated for osteoporosis were: age over 50, prior fracture and female gender, while predictors for treatment were: age over 50 and having been investigated. This study has confirmed low rates of investigation and treatment even in individuals who have already suffered a prior fracture, and especially in those <50 and in males. People with moderate and minimal trauma fractures had similar risk factors for osteoporosis, including a similarly high proportion of prior fractures. These findings support the concept that people with moderate trauma fractures are at higher subsequent fracture risk, yet are neither investigated nor treated. This study highlights the need for further exploration of barriers to osteoporosis management.
即使对于有既往骨折史的高危人群，骨质疏松症的管理也并不理想。还有证据表明，中度创伤骨折患者的骨密度较低，后续骨折风险更高。本研究旨在确定影响骨质疏松症高危个体管理的因素，并检查轻度和中度创伤骨折个体的风险状况。对悉尼圣文森特医院门诊骨折诊所连续15个月（2002年2月至2003年7月）治疗的骨折患者（n = 218）进行了访谈。收集骨折危险因素、既往骨质疏松症的检查和治疗情况，并在3个月后联系参与者以确定随访情况。骨质疏松症的危险因素，包括家族史、饮食钙摄入低以及与骨质流失相关的疾病，在轻度和中度创伤组之间以及不同性别之间相似。尽管一半的参与者有既往骨折史，但只有34%进行了骨密度扫描，16%接受了抗吸收治疗。在3个月的随访中，检查和治疗率仅有轻微（6%）增加，中度创伤组和男性增加更少。骨质疏松症检查的独立预测因素为：年龄超过50岁、既往骨折和女性性别，而治疗的预测因素为：年龄超过50岁且已接受检查。本研究证实，即使是已经有过既往骨折的个体，检查和治疗率也很低，尤其是年龄<50岁的个体和男性。轻度和中度创伤骨折患者的骨质疏松症危险因素相似，包括既往骨折比例同样较高。这些发现支持了这样一种观点，即中度创伤骨折患者后续骨折风险更高，但既未接受检查也未接受治疗。本研究强调需要进一步探索骨质疏松症管理的障碍。
