Bliuc D, Eisman J A, Center J 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. 2006;17(9):1309-17. doi: 10.1007/s00198-006-0078-1. Epub 2006 Jun 21.
Despite the high risk for subsequent fracture following an initial osteoporotic fracture, the majority of subjects with minimal trauma fractures receive no treatment for osteoporosis. The primary aim of this investigation was to determine whether an information-based intervention could change post-fracture management of osteoporosis. A secondary aim was to define participant- and doctor-related barriers to osteoporosis management.
Consecutive fracture patients (n=254) from the outpatient fracture clinic at St Vincent's Hospital, Sydney were interviewed over a 15-month period (February 2002-July 2003). Fracture risk factors, prior investigation and treatment for osteoporosis were collected at baseline. Participants were initially contacted after 3 months to ascertain follow-up management. All those not investigated or treated by their primary care physician were then randomized to either a personalized letter or the same letter plus an offer of a free bone mineral density (BMD) test. Participants were contacted after 9 months to record further investigations or treatment for osteoporosis.
Less than 20% of the participants had a primary care physician follow-up 3 months after the fracture, leaving 159 who were randomized to a personalized letter (n=79) and a personalized letter plus the offer of a free BMD test (n=80). There was a significant increase in the number of people investigated for osteoporosis in the group receiving the letter plus BMD offer [38% (letter + BMD) vs. 7% (letter only); p=0.001). A high proportion of those tested had low BMD (49% osteopenia and 17% osteoporosis). However, the rates of treatment in both groups were very low (6%). Furthermore, even among the few individuals (23%) who contacted their primary care physician, only 25% were recommended treatment. The belief that the fracture was osteoporotic was an independent predictor of having a BMD test, a primary care physician follow-up and treatment. Other independent predictors were age over 50 years for a primary care physician follow-up, female sex for having a BMD test and having had a BMD test for treatment.
This study demonstrates that an information-based intervention led to a modest increase in the proportion of people investigated for osteoporosis; however. there was no significant effect on treatment rates. The offer of a free BMD assessment was associated with a significantly higher rate of investigation than a personalized letter alone (odds ratio: 8.5; 95% confidence interval: 3.1-24.5), but this investigation did not affect treatment rate. The low uptake of either a BMD or a visit to a primary care physician together with low rates of treatment recommendation even among people who contacted their primary care physician reflects significant participant and doctor-related barriers to osteoporosis management.
尽管初次骨质疏松性骨折后再次骨折的风险很高，但大多数轻度创伤骨折患者未接受骨质疏松症治疗。本研究的主要目的是确定基于信息的干预措施是否能改变骨折后骨质疏松症的管理。次要目的是确定与参与者和医生相关的骨质疏松症管理障碍。
在15个月期间（2002年2月至2003年7月），对悉尼圣文森特医院门诊骨折诊所的连续骨折患者（n = 254）进行了访谈。在基线时收集骨折危险因素、先前对骨质疏松症的检查和治疗情况。3个月后最初联系参与者以确定后续管理情况。然后，所有未由其初级保健医生进行检查或治疗的患者被随机分为两组，一组收到个性化信件，另一组收到相同信件并外加免费骨密度（BMD）检测的提议。9个月后联系参与者以记录进一步的骨质疏松症检查或治疗情况。
骨折后3个月，不到20%的参与者接受了初级保健医生的随访，剩下159人被随机分为两组，一组收到个性化信件（n = 79），另一组收到个性化信件并外加免费BMD检测的提议（n = 80）。在收到信件并外加BMD检测提议的组中，接受骨质疏松症检查的人数显著增加[38%（信件+BMD）对7%（仅信件）；p = 0.001]。接受检测的人群中很大一部分骨密度较低（49%为骨量减少，17%为骨质疏松）。然而，两组的治疗率都非常低（6%）。此外，即使在少数联系了初级保健医生的个体（23%）中，只有25%被建议接受治疗。认为骨折是由骨质疏松症引起的这一信念是进行BMD检测、接受初级保健医生随访和治疗的独立预测因素。其他独立预测因素包括：年龄超过50岁是接受初级保健医生随访的预测因素，女性是进行BMD检测的预测因素，曾经进行过BMD检测是接受治疗的预测因素。
本研究表明，基于信息的干预措施使接受骨质疏松症检查的人群比例略有增加；然而，对治疗率没有显著影响。提供免费BMD评估与仅收到个性化信件相比，检查率显著更高（优势比：8.5；95%置信区间：3.1 - 24.5），但这种检查并未影响治疗率。BMD检测或拜访初级保健医生的接受率较低，即使在联系了初级保健医生的人群中治疗建议率也很低，这反映了与参与者和医生相关的显著的骨质疏松症管理障碍。
