Rozental Tamara D, Makhni Eric C, Day Charles S, Bouxsein Mary L
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA.
J Bone Joint Surg Am. 2008 May;90(5):953-61. doi: 10.2106/JBJS.G.01121.
Fragility fractures are associated with a significant increase in the risk of future fracture, but the rates of evaluation to identify osteoporosis after such injuries are low. The purpose of this study was to determine the rates of evaluation and treatment of osteoporosis following distal radial fractures and to test two interventions in the outpatient clinic to improve evaluation and treatment rates.
In the first part of the study, the medical records of 298 consecutive patients treated for a fragility fracture of the distal part of the radius were reviewed. Primary outcome measures were a bone mineral density examination and treatment with osteoporosis medication within six months after the fracture. In the second part of the study, fifty patients with a fragility fracture of the distal part of the radius were prospectively randomized to receive one of two interventions. These consisted of (1) the orthopaedic surgeon ordering a bone mineral density examination and forwarding the results to the primary care physician or (2) the orthopaedic surgeon sending a letter to the primary care physician outlining guidelines for osteoporosis screening. Patients were contacted at six months after the fracture to determine the rates of evaluation and treatment for osteoporosis.
The first part of the study revealed that, following a distal radial fracture, 21.3% of 240 patients had a bone mineral density examination and 78.7% were never screened. Osteopenia was the most common diagnosis among those screened (57%). Most (72.5%) of the 240 patients received no medication, whereas 6.7% received calcium and vitamin D; 11.3%, bisphosphonates; 2.5%, hormone replacement therapy; and 7.1%, a combination regimen. The treatment rate for the patients who had undergone a bone mineral density examination was 2.5-fold higher than the rate for those who had not had bone mineral density testing (53% compared with 21%, p < 0.001). In the second part of the study, the patients randomized to Intervention 1 had two to threefold greater rates of bone mineral density testing (93% compared with 30%, p < 0.001), discussion of osteoporosis with their primary care physician (89% compared with 35%, p < 0.001), and initiation of osteoporosis therapy (74% compared with 26%, p < 0.001) compared with patients randomized to Intervention 2.
Rates of evaluation and treatment for osteoporosis after fragility fractures remain low (21.3% and 27.5%, respectively). Patients who undergo a bone mineral density examination are more likely to receive treatment. Ordering a bone mineral density examination in the orthopaedic clinic can dramatically improve osteoporosis evaluation and treatment rates following fragility fractures of the distal part of the radius.
脆性骨折与未来骨折风险的显著增加相关，但此类损伤后用于识别骨质疏松症的评估率较低。本研究的目的是确定桡骨远端骨折后骨质疏松症的评估和治疗率，并在门诊测试两种干预措施以提高评估和治疗率。
在研究的第一部分，回顾了298例连续接受桡骨远端脆性骨折治疗的患者的病历。主要结局指标为骨折后6个月内的骨密度检查和骨质疏松症药物治疗。在研究的第二部分，50例桡骨远端脆性骨折患者被前瞻性随机分组，接受两种干预措施之一。这些措施包括：（1）骨科医生开具骨密度检查并将结果转发给初级保健医生；或（2）骨科医生给初级保健医生发送一封信，概述骨质疏松症筛查指南。在骨折后6个月联系患者，以确定骨质疏松症的评估和治疗率。
研究的第一部分显示，桡骨远端骨折后，240例患者中有21.3%进行了骨密度检查，78.7%从未接受过筛查。骨质减少是筛查患者中最常见的诊断（57%）。240例患者中大多数（72.5%）未接受药物治疗，而6.7%接受了钙和维生素D；11.3%接受了双膦酸盐；2.5%接受了激素替代疗法；7.1%接受了联合治疗方案。接受骨密度检查的患者的治疗率比未进行骨密度检测的患者高2.5倍（53%对21%，p<0.001）。在研究的第二部分，与随机分配到干预措施2的患者相比，随机分配到干预措施1的患者进行骨密度检测的比率高两到三倍（93%对30%，p<0.001），与初级保健医生讨论骨质疏松症的比率高两到三倍（89%对35%，p<0.001），开始骨质疏松症治疗的比率高两到三倍（74%对26%，p<0.001）。
脆性骨折后骨质疏松症的评估和治疗率仍然较低（分别为21.3%和27.5%）。接受骨密度检查的患者更有可能接受治疗。在骨科诊所开具骨密度检查可以显著提高桡骨远端脆性骨折后骨质疏松症的评估和治疗率。
