Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi J D
Department of Kinesiology, University of Waterloo, Waterloo, Canada and Adjunct Scientist, Toronto Rehabilitation Institute, Toronto, Canada.
Semin Arthritis Rheum. 2006 Apr;35(5):293-305. doi: 10.1016/j.semarthrit.2005.11.001.
To describe practice patterns in the management of osteoporosis after fragility fracture.
Systematic review of articles in MEDLINE, EMBASE, Cochrane, and CINAHL databases (1996 to February 2005). Diagnostic outcomes included clinical osteoporosis diagnoses, laboratory tests, and bone density scans. Treatment outcomes included initiation of calcium, vitamin D, hormone replacement therapy, bisphosphonates, calcitonin, raloxifene and falls assessments.
Thirty-five studies met our inclusion criteria and demonstrated that adults who experience fragility fracture are not receiving osteoporosis management. An osteoporosis diagnosis was reported in 1 to 45% of patients with fractures; laboratory tests were ordered for 1 to 49% and 1 to 32% of patients had bone density scans. Calcium/vitamin D and pharmacological therapy was reported in 2 to 62% and 1 to 65% of patients, respectively. Osteoporosis treatment was recommended more often in women than men, and more often in patients with vertebral fractures than in patients with nonvertebral fractures. Older patients were more likely to be diagnosed with osteoporosis, but treatment was more likely in younger patients. A history of prior fracture was reported in 7 to 67% of patients. Between 1 and 22% of patients had a subsequent fracture during follow-up periods of 6 months to 5 years. Falls assessments were not often reported; when they were, they were infrequently performed. A greater proportion of patients were diagnosed/treated during follow-up studies than in studies evaluating diagnosis/treatment on discharge from acute care.
The majority of individuals who sustain fragility fractures are not receiving adequate osteoporosis management. Future research should address barriers to appropriate management and the efficacy of implementation strategies designed to close the osteoporosis care gap.
This article is of particular importance to health care professionals who provide care for patients with fragility fracture.
描述脆性骨折后骨质疏松症管理的实践模式。
对MEDLINE、EMBASE、Cochrane和CINAHL数据库（1996年至2005年2月）中的文章进行系统综述。诊断结果包括临床骨质疏松症诊断、实验室检查和骨密度扫描。治疗结果包括钙、维生素D、激素替代疗法、双膦酸盐、降钙素、雷洛昔芬的起始使用以及跌倒评估。
35项研究符合我们的纳入标准，表明经历脆性骨折的成年人未接受骨质疏松症管理。骨折患者中1%至45%被报告有骨质疏松症诊断；1%至49%的患者接受了实验室检查，1%至32%的患者进行了骨密度扫描。分别有2%至62%和1%至65%的患者报告使用了钙/维生素D和药物治疗。女性比男性更常被推荐进行骨质疏松症治疗，椎体骨折患者比非椎体骨折患者更常接受治疗。老年患者更有可能被诊断为骨质疏松症，但年轻患者更有可能接受治疗。7%至67%的患者有既往骨折史。在6个月至5年的随访期内，1%至22%的患者再次发生骨折。跌倒评估报告不常见；即便有报告，也很少进行评估。与评估急性护理出院时的诊断/治疗的研究相比，随访研究中被诊断/治疗的患者比例更高。
大多数发生脆性骨折的个体未得到充分的骨质疏松症管理。未来的研究应解决适当管理的障碍以及旨在缩小骨质疏松症护理差距的实施策略的有效性。
本文对为脆性骨折患者提供护理的医疗保健专业人员尤为重要。
