Quintos-Macasa Anne-Marie, Quinet Robert, Spady Malik, Zakem Jerald, Davis William, Menon Yamini, Serebro Leonard, Krousel-Wood M A
Department of Rheumatology, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
J Clin Rheumatol. 2007 Apr;13(2):70-2. doi: 10.1097/01.rhu.0000260497.84746.dd.
Osteoporosis remains an underdiagnosed and undertreated major health problem. The current treatment rate for patients who have experienced at least 1 osteoporotic fracture is 20%-25%. Therefore, the Rheumatology and Internal Medicine Departments of Ochsner Clinic Foundation New Orleans implemented a mandatory rheumatology osteoporosis consult as part of preprinted admission orders for all patients after hip fracture surgery on the Internal Medicine service.
We conducted a retrospective study of 78 patients admitted with a low-impact hip fracture between June 2004 and July 2005. These patients were seen by the rheumatology service in the hospital after hip fracture repair (exposed group). Osteoporosis evaluation was performed based on an interview questionnaire. Seventy-eight age-matched patients previously admitted for low-intensity or low-impact hip fracture in 2002-2003 but not exposed to the mandatory rheumatology consult served as our comparison group. Pearson chi2 test was used for statistical analysis.
Mean patient age was 80 years. Of the 78 unexposed patients, 17 (22%) were on treatment (calcium, vitamin D, hormones or antiresorptive agents) before the hip fracture, and 18 (23%) were on treatment after fracture repair. Of the 78 patients exposed to the compulsory rheumatology consultation, 34 (44%) patients were receiving osteoporosis treatment before hip fracture and 75 (96%) patients were receiving treatment after fracture repair. Of the patients not treated before hip fracture repair, there was a significant increase in the percent treated for those patients exposed to the rheumatology consult versus those not exposed (97.6% vs. 2.4%, respectively, P < 0.0001).
In our institution, we were successful in identifying and initiating appropriate therapy for osteoporosis patients through an automatic rheumatology osteoporosis consultation after hip fracture. The implementation of a mandatory osteoporosis consult resulted in a statistically significant increase in treatment of the exposed group compared with the unexposed group.
骨质疏松症仍然是一个诊断不足且治疗不充分的重大健康问题。经历过至少一次骨质疏松性骨折的患者目前的治疗率为20%-25%。因此，新奥尔良奥施纳诊所基金会的风湿病科和内科将强制性风湿病骨质疏松症会诊作为内科服务中所有髋部骨折手术后患者预印入院医嘱的一部分。
我们对2004年6月至2005年7月期间因低能量髋部骨折入院的78例患者进行了回顾性研究。这些患者在髋部骨折修复后由医院的风湿病科诊治（暴露组）。基于访谈问卷进行骨质疏松症评估。78例年龄匹配的患者在2002 - 2003年因低能量或低能量髋部骨折入院，但未接受强制性风湿病会诊，作为我们的对照组。采用Pearson卡方检验进行统计分析。
患者平均年龄为80岁。在78例未暴露患者中，17例（22%）在髋部骨折前接受治疗（钙、维生素D、激素或抗吸收剂），18例（23%）在骨折修复后接受治疗。在78例接受强制性风湿病会诊的患者中，34例（44%）在髋部骨折前接受骨质疏松症治疗，75例（96%）在骨折修复后接受治疗。在髋部骨折修复前未接受治疗的患者中，接受风湿病会诊的患者与未接受会诊的患者相比，接受治疗的百分比有显著增加（分别为97.6%和2.4%，P < 0.0001）。
在我们的机构中，通过髋部骨折后自动进行的风湿病骨质疏松症会诊，我们成功地识别并为骨质疏松症患者启动了适当的治疗。与未暴露组相比，强制性骨质疏松症会诊显著增加了暴露组的治疗率。
