Shah Shinil K, Gecys Gintare T
Department of Surgery, University of Texas Medical School at Houston, USA.
J Am Osteopath Assoc. 2006 Nov;106(11):653-7.
Glucocorticoids are used for a variety of medical conditions. This class of drugs is arguably the most common cause of iatrogenic osteoporosis, but studies have shown that physicians are not investigating and treating glucocorticoid-induced osteoporosis.
To determine whether primary care physicians (osteopathic and allopathic) are evaluating and treating adult patients at risk for osteoporosis secondary to long-term prednisone use.
Electronic medical records from three primary care practices (family medicine, geriatric medicine, and internal medicine) were retrospectively reviewed to identify patients who were taking at least 2.5 mg of prednisone per day for 8 weeks or longer. Records were then grouped according to whether patients had undergone bone mineral density screening and had been given therapy to prevent or treat bone loss. Whether patients had comorbid risk factors for secondary osteoporosis (according to the National Institutes of Health Consensus Development Conference Statement on Osteoporosis) was noted to determine whether treatment was given because of prednisone use or because of the comorbid risk factors. Statistical analysis was performed using a Pearson product moment correlation 2-tailed chi2 test.
The medical records of 49 patients met inclusion criteria (19 men, 30 women; mean age, 61 years; age range, 21-89 years). A statistically significant difference was found in physician evaluation practices for patients with vs patients without comorbid risk factors (82.1% vs 38.1%; P=.002).
Primary care physicians do not routinely evaluate patients for osteoporosis secondary to glucocorticoid treatment, especially when patients do not have comorbid risk factors for osteoporosis.
糖皮质激素用于多种医疗状况。这类药物可以说是医源性骨质疏松最常见的病因，但研究表明医生并未对糖皮质激素诱发的骨质疏松进行调查和治疗。
确定基层医疗医生（整骨疗法医生和西医医生）是否对长期使用泼尼松继发骨质疏松风险的成年患者进行评估和治疗。
回顾性审查来自三个基层医疗科室（家庭医学、老年医学和内科）的电子病历，以识别每天服用至少2.5毫克泼尼松持续8周或更长时间的患者。然后根据患者是否接受了骨密度筛查以及是否接受了预防或治疗骨质流失的治疗对记录进行分组。记录患者是否存在继发性骨质疏松的合并危险因素（根据美国国立卫生研究院关于骨质疏松症的共识发展会议声明），以确定治疗是因为使用泼尼松还是因为合并危险因素。使用Pearson积差相关双尾卡方检验进行统计分析。
49例患者的病历符合纳入标准（19名男性，30名女性；平均年龄61岁；年龄范围21-89岁）。在有合并危险因素与无合并危险因素的患者中，医生的评估做法存在统计学上的显著差异（82.1%对38.1%；P=0.002）。
基层医疗医生通常不会对糖皮质激素治疗继发骨质疏松的患者进行评估，尤其是当患者没有骨质疏松的合并危险因素时。
