Ledwich Lindsay J, Clarke Kofi
Western Pennsylvania Hospital, Pittsburgh, Pennsylvania, USA.
J Clin Rheumatol. 2009 Mar;15(2):61-4. doi: 10.1097/RHU.0b013e31819b65bd.
Despite increased awareness of glucocorticoid-induced osteoporosis, physicians are not providing recommended screening and treatment. The number of patients receiving bone density measurements, primary prevention, and secondary treatment remains low.
To analyze physician adherence of rheumatologists in an urban multispecialty group to the American College of Rheumatology 2001 ad hoc committee guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis (RA).
The practice evaluated is a multispecialty practice in an urban setting affiliated with a teaching hospital. A retrospective chart review was performed. The names of 428 patients with RA were obtained by billing query. One hundred thirty-six charts met criteria for final analysis. Charts were reviewed for long-term corticosteroid use >or=5 mg/d for >or=6 months, baseline bone density scans, use of calcium and vitamin D, use of hormone replacement therapy, use of calcitonin, and use of a bisphosphonate.
59.7% of patients qualified as long-term corticosteroid users. Only 37% of long-term corticosteroid users received baseline bone density scans. Bone loss was documented in 70.4% of corticosteroid users who received baseline DEXA scans. Only 38.9% of long-term corticosteroid users received the recommended treatment of bisphosphonates or HRT with calcium plus vitamin D according to ACR guidelines.
Less then 40% of long-term corticosteroid users with RA received recommended DEXA scanning and treatment in a multispecialty rheumatology urban practice.
尽管对糖皮质激素诱导的骨质疏松症的认识有所提高，但医生并未提供推荐的筛查和治疗。接受骨密度测量、一级预防和二级治疗的患者数量仍然很低。
分析城市多专科医疗组中风湿病学家对美国风湿病学会2001年特设委员会关于类风湿关节炎（RA）患者糖皮质激素诱导的骨质疏松症预防和治疗指南的遵循情况。
所评估的医疗机构是一家与教学医院相关的城市多专科医疗机构。进行了回顾性病历审查。通过计费查询获得了428例RA患者的姓名。136份病历符合最终分析标准。审查病历以了解长期使用皮质类固醇≥5毫克/天≥6个月、基线骨密度扫描、钙和维生素D的使用、激素替代疗法的使用、降钙素的使用以及双膦酸盐的使用情况。
59.7%的患者符合长期使用皮质类固醇的标准。长期使用皮质类固醇的患者中只有37%接受了基线骨密度扫描。在接受基线双能X线吸收测定扫描的皮质类固醇使用者中，70.4%记录有骨质流失。根据美国风湿病学会指南，长期使用皮质类固醇的患者中只有38.9%接受了推荐的双膦酸盐或激素替代疗法加钙和维生素D的治疗。
在城市多专科风湿病医疗实践中，不到40%的长期使用皮质类固醇的RA患者接受了推荐的双能X线吸收测定扫描和治疗。
