Edwards Beatrice J, Iris Madelyn, Ferkel Eric, Feinglass Joseph
Department of Medicine, The Feinberg School of Medicine Northwestern University, Bone Health and Osteoporosis Program, 676 N St Clair, Suite 200 Chicago, IL 60611, USA.
Maturitas. 2006 Feb 20;53(3):260-6. doi: 10.1016/j.maturitas.2005.05.008. Epub 2005 Jul 21.
To explore barriers to medical care for osteoporosis following a minimal trauma fracture (MTF). MTFs occur from a fall while in a seated, recumbent or standing position; during normal walking, or from a height less than 4 feet.
Prospective study and focus groups of women with MTF performed in Chicago from June to December of 2003. Study protocol approved by Institutional Review Board (IRB) and all participants signed consent forms. Focus groups were audiotaped and transcribed, transcripts analyzed using Atlas.ti. Survey results analyzed with SPSS 11.5.
Twenty nine participants recruited with average age of 74+/-16 years. MTF occurred at the mean age of 61+/-8 years, with fifteen (15/29) reporting more that one prior MTF. The age distribution was 40-49 years 2 (2/29) participants, 50-59 years 2 (2/29), 60-69 years 6 (6/29), 70-79 years 10 (10/29), 80 and above 9 (9/29). Most participants (21/29, 70%) reported knowledge about osteoporosis obtained from written media. Osteoporotic fractures were rated on a single item Likert Scale (1=not important to 5=most important) as 2.5 (compared with breast cancer 2.3, and myocardial infarction 2.8). Half (16/29) had osteoporosis counseling with their PCP and 9 were receiving medications for bone loss. We observed a positive correlation between osteoporosis counseling and BMD testing (r=0.6, p<0.001), and a trend toward osteoporosis treatment (r=0.372, p=0.09). Half of the participants had reported the occurrence of MTF to their PCP (14/29), however this did not lead to counseling, BMD testing (r=0.07, p=0.78), or treatment (r=-0.14, p=0.53). None of the women believed that low BMD or osteoporosis had contributed to their fracture. Women studied believed that they were "too young" (12/29) to have osteoporosis.
Women are not receiving adequate information about osteoporosis; they remain unaware of the connection between MTFs and osteoporosis. Post-menopausal women with MTF do not identify osteoporosis as a cause for the fracture, may exhibit ageism and thereby fail to seek adequate medical care.
探讨轻微创伤骨折（MTF）后骨质疏松症医疗护理的障碍。MTF 是指在坐姿、卧位或站立位跌倒时发生的骨折；在正常行走过程中发生的骨折，或从低于 4 英尺的高度坠落导致的骨折。
2003 年 6 月至 12 月在芝加哥对发生 MTF 的女性进行前瞻性研究和焦点小组访谈。研究方案经机构审查委员会（IRB）批准，所有参与者均签署了知情同意书。焦点小组访谈进行了录音和转录，转录文本使用 Atlas.ti 进行分析。调查结果使用 SPSS 11.5 进行分析。
招募了 29 名参与者，平均年龄为 74±16 岁。MTF 发生的平均年龄为 61±8 岁，其中 15 名（15/29）报告有不止一次既往 MTF。年龄分布为 40 - 49 岁 2 名（2/29）参与者，50 - 59 岁 2 名（2/29），60 - 69 岁 6 名（6/29），70 - 79 岁 10 名（10/29），80 岁及以上 9 名（9/29）。大多数参与者（21/29，70%）报告从书面媒体获得了有关骨质疏松症的知识。骨质疏松性骨折在单项李克特量表（1 = 不重要至 5 = 最重要）上的评分是 2.5（与乳腺癌 2.3 和心肌梗死 2.8 相比）。一半（16/29）的参与者与其初级保健医生（PCP）进行了骨质疏松症咨询，9 名正在接受治疗骨质流失的药物。我们观察到骨质疏松症咨询与骨密度检测之间存在正相关（r = 0.6，p < 0.001），以及骨质疏松症治疗的趋势（r = 0.372，p = 0.09）。一半的参与者向其 PCP 报告了 MTF 的发生情况（14/29），然而这并未导致咨询、骨密度检测（r = 0.07，p = 0.78）或治疗（r = -0.14，p = 0.53）。没有女性认为低骨密度或骨质疏松症导致了她们的骨折。参与研究的女性认为她们“太年轻”（12/29）而不会患骨质疏松症。
女性未获得关于骨质疏松症的充分信息；她们仍然未意识到 MTF 与骨质疏松症之间的联系。发生 MTF 的绝经后女性未将骨质疏松症视为骨折的原因，可能表现出年龄歧视，从而未能寻求充分的医疗护理。
