男性骨质疏松症筛查：家庭医生是否遵循指南？
Osteoporosis screening for men: are family physicians following the guidelines?
作者信息
Cheng Natalie, Green Michael E
机构信息
Enhanced Rural Skills, Queen's University in Kingston, Ontario, Canada.
出版信息
Can Fam Physician. 2008 Aug;54(8):1140-1141, 1141.e1-5.
OBJECTIVE
To determine rates of screening for osteoporosis among men older than 65 years and to find out whether family physicians are following the recommendations of the Osteoporosis Society of Canada's 2002 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada.
DESIGN
Chart audit.
SETTING
The Family Medicine Centre at Hotel Dieu Hospital in Kingston, Ont.
PARTICIPANTS
All male patients at the Family Medicine Centre older than 65 years for a total of 565 patients associated with 20 different physicians' practices.
MAIN OUTCOME MEASURES
Rates of screening with bone mineral density (BMD) scans for osteoporosis, results of BMD testing, and associations between results of BMD testing and age.
RESULTS
Of the 565 patients reviewed, 108 (19.1% of the study population) had received BMD testing. Rates of screening ranged from 0% to 38% in the 20 practices. Among 105 patients tested (reports for 3 patients were not retrievable), 15 (14.3%) were found to have osteoporosis, 43 (41.0%) to have osteopenia, and 47 (44.8%) to have normal BMD results. No significant association was found between BMD results and age. Screening rates were higher among men older than 75 years than among men aged 65 to 75 and peaked among those 85 to 89 years old.
CONCLUSION
On average, only about 20% of male patients older than 65 years had been screened for osteoporosis, so most of these men were not being screened by BMD testing as recommended in the guidelines. Considering the relatively high rates of osteoporosis and osteopenia found in this study and the known morbidity and mortality associated with osteoporotic fractures in this population, higher rates of BMD screening and more widespread treatment of osteoporosis could prevent many fractures among these patients. Family physicians need to become more aware of the risk factors indicating screening, and barriers to screening and treatment of osteoporosis in men need to be identified and addressed.
目的
确定65岁以上男性骨质疏松症的筛查率，并了解家庭医生是否遵循加拿大骨质疏松协会2002年《加拿大骨质疏松症诊断和管理临床实践指南》的建议。
设计
图表审核。
地点
安大略省金斯敦市迪厄医院家庭医学中心。
参与者
家庭医学中心所有65岁以上男性患者，共565名患者，涉及20位不同医生的诊疗实践。
主要观察指标
骨质疏松症骨密度（BMD）扫描筛查率、BMD检测结果以及BMD检测结果与年龄之间的关联。
结果
在审查的565名患者中，108名（占研究人群的19.1%）接受了BMD检测。20个诊疗实践中的筛查率从0%到38%不等。在接受检测的105名患者中（3名患者的报告无法获取），15名（14.3%）被诊断为骨质疏松症，43名（41.0%）为骨质减少，47名（44.8%）BMD结果正常。未发现BMD结果与年龄之间存在显著关联。75岁以上男性的筛查率高于65至75岁男性，在85至89岁男性中达到峰值。
结论
平均而言，65岁以上男性患者中只有约20%接受了骨质疏松症筛查，因此这些男性中的大多数未按照指南建议进行BMD检测筛查。鉴于本研究中发现的骨质疏松症和骨质减少症的相对高发病率以及该人群中已知的骨质疏松性骨折相关的发病率和死亡率，更高的BMD筛查率和更广泛的骨质疏松症治疗可以预防这些患者中的许多骨折。家庭医生需要更加了解表明需要筛查骨质疏松症的风险因素，并且需要识别和解决男性骨质疏松症筛查和治疗的障碍。
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