Pickney Cynthia S, Arnason Jon A
University of Wisconsin, Madison, Wisconsin, USA.
Osteoporos Int. 2005 Sep;16(9):1156-60. doi: 10.1007/s00198-004-1818-8. Epub 2005 Mar 3.
Treatment of osteoporosis is often inadequate. One reason can be insufficient patient education following diagnostic bone densitometry (DXA). Therefore, we studied how patients are informed and treated following their first DXA. Individuals who had DXA at a rural hospital in Wisconsin were surveyed with a questionnaire regarding their post-test education and prescribed treatment. Their DXA results and the specialty of their clinician were also recorded. Eighty percent of the 1,014 participants were informed of their results. Of the 341 participants who had normal bone mineral density (BMD), 63% reported correct results, while only 31% of the 309 who had osteopenia and 50% of the 364 who had osteoporosis reported correct results. Accuracy in reporting was not affected by the patients' age or the specialty of their clinicians. Following DXA, 339 patients (33%) were started on medications; 86% of those remained on some prescribed therapy for osteoporosis, but 140 (41%) did not continue the initial medication. Reasons for discontinuation included side effects (48%) and cost (26%). Patients with low BMD who correctly reported their results were more likely to have received a medication and to continue to take it ( p <0.0001). Calcium supplements were recommended to 65% of those not taking calcium prior to DXA. Internists were more likely than family practitioners to recommend calcium, and their patients reported better medication adherence, as did those with osteoporosis compared with osteopenia. We conclude that, while most participants are informed of the results of their DXAs, the retained information may not be accurate. Correct understanding of DXA results may lead to higher treatment rates and better adherence to treatment among patients with low BMD.
骨质疏松症的治疗往往不充分。一个原因可能是诊断性骨密度测定(DXA)后患者教育不足。因此,我们研究了患者在首次DXA检查后是如何得到信息告知及接受治疗的。对在威斯康星州一家乡村医院进行DXA检查的个体进行问卷调查,内容涉及检查后的教育情况及所开的治疗方案。还记录了他们的DXA结果及临床医生的专业。1014名参与者中有80%被告知了检查结果。在341名骨矿物质密度(BMD)正常的参与者中,63%报告的结果正确,而在309名骨量减少者中只有31%、364名骨质疏松患者中只有50%报告的结果正确。报告的准确性不受患者年龄或临床医生专业的影响。DXA检查后,339名患者(33%)开始用药;其中86%继续接受某种骨质疏松症的规定治疗,但140名(41%)没有继续使用最初的药物。停药原因包括副作用(48%)和费用(26%)。正确报告结果的低BMD患者更有可能接受药物治疗并持续用药(p<0.0001)。65%在DXA检查前未服用钙的患者被建议补充钙剂。内科医生比家庭医生更有可能建议补充钙剂,而且他们的患者报告的药物依从性更好,骨质疏松患者与骨量减少患者相比也是如此。我们得出结论,虽然大多数参与者被告知了DXA检查结果,但所保留的信息可能不准确。对DXA结果的正确理解可能会提高低BMD患者的治疗率并改善治疗依从性。