Sikon Andrea L, Thacker Holly L, Carey John, Deal Chad, Licata Angelo A
Women's Health Center, The Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA.
J Womens Health (Larchmt). 2006 Dec;15(10):1174-83. doi: 10.1089/jwh.2006.15.1174.
As a growing percentage of Americans will be reaching their elderly years in the next decade, the prevalence of osteoporosis and its effects will have an even greater impact on the healthcare system. Advancements in bone research and development of newer treatments have allowed for the establishment of more refined guidelines and a growing awareness of the need to prevent, screen, and diagnose osteoporosis. Thus, more women are now being screened with dual x-ray absorptiometry scans (DXA) than ever before. The importance of a true understanding of the test results obtained from such screening is paramount. In our institution, recommendations to consider a secondary evaluation are made by the DXA interpreters when the Z-score is low. Few, if any, studies have evaluated the rates of physician and patient adherence with specific recommendations provided on the bone density report.
To assess compliance with such recommendations provided in DXA interpretations, we investigated the number of ordering providers who actually pursued these advisements.
We found that among providers ordering DXAs, primary care providers did not pursue recommendations to pursue a secondary workup as often as their subspecialty counterparts. We also found a significant amount of vitamin D deficiency/insufficiency and primary hyperparathyroidism in the population evaluated.
Primary care providers should be further educated on treatable secondary causes of osteoporosis as opposed to an often reflexive response of prescribing a pharmacological antiresportive agent without other consideration.
在未来十年中，随着美国老年人口比例的不断增加，骨质疏松症的患病率及其影响将对医疗保健系统产生更大的影响。骨骼研究的进展和新治疗方法的开发使得能够制定更完善的指南，并且人们越来越意识到预防、筛查和诊断骨质疏松症的必要性。因此，现在接受双能X线吸收测定扫描（DXA）筛查的女性比以往任何时候都多。真正理解此类筛查获得的检测结果至关重要。在我们机构中，当Z值较低时，DXA解读人员会建议考虑进行二次评估。很少有研究评估医生和患者对骨密度报告中提供的具体建议的遵循率。
为了评估对DXA解读中提供的此类建议的依从性，我们调查了实际遵循这些建议的开单医生的数量。
我们发现，在开具DXA检查单的医生中，初级保健医生不像其专科同行那样经常遵循进行二次检查的建议。我们还发现，在接受评估的人群中存在大量维生素D缺乏/不足和原发性甲状旁腺功能亢进。
应进一步对初级保健医生进行关于可治疗的继发性骨质疏松症病因的教育，而不是通常不假思索地开具抗骨质疏松药物而不考虑其他因素。
