Buencamino Maria Clarinda A, Sikon Andrea L, Jain Anil, Thacker Holly L
Department of General Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Womens Health (Larchmt). 2009 Jun;18(6):873-81. doi: 10.1089/jwh.2008.0897.
Osteopenia/low bone mineral density (BMD) can lead to osteoporosis and is far more prevalent than osteoporosis. The National Osteoporosis Foundation (NOF) has recommendations for prevention and treatment of low BMD; however, the condition remains underrecognized and undertreated. We assessed practice patterns between physician knowledge of low BMD and prescribing of additional pharmacological therapies as defined by the NOF guidelines.
This is a retrospective, observational chart review of electronic medical records of 99 postmenopausal women aged > or =60 years with T-scores between -1.0 and -2.5 on baseline BMD done in 2003 at the Cleveland Clinic Women's Health Center. Counseling, advisement of weightbearing exercise, recommendation of calcium and vitamin D supplementation, and adequate pharmacological therapy in the form of bisphosphonates, hormone therapy, or selective estrogen receptor modulators (SERMs) were assessed. The management of bone specialists credentialed both by the International Society of Clinical Densitometry and the North American Menopause Society and non-bone specialists was also compared.
Bone specialists were more likely than non-bone specialists to offer counseling in the form of letters, phone encounters, and follow-up office visits and recommend weightbearing exercises. Most physicians recommended calcium and vitamin D supplementation regardless of specialty. There is no significant difference in the prescribing of pharmacological agents vs. conservative measures for osteopenic postmenopausal women by non-bone specialists vs. bone specialists as defined by the NOF guidelines, such that non-bone specialists did not treat these women any less aggressively than did bone specialists.
Osteopenia is adequately managed in our institution regardless of physician group. However, non-bone specialists should consider more direct counseling about bone health and consider advisement of weightbearing exercise.
骨量减少/低骨矿物质密度（BMD）可导致骨质疏松症，且比骨质疏松症更为普遍。美国国家骨质疏松症基金会（NOF）对低骨密度的预防和治疗有相关建议；然而，这种情况仍然未得到充分认识和治疗。我们评估了医生对低骨密度的了解与按照NOF指南规定开具额外药物治疗之间的实践模式。
这是一项对99名年龄≥60岁绝经后女性电子病历的回顾性观察图表审查，这些女性在2003年克利夫兰诊所妇女健康中心进行的基线骨密度检查中T值在-1.0至-2.5之间。评估了咨询、负重锻炼建议、钙和维生素D补充剂的推荐，以及以双膦酸盐、激素疗法或选择性雌激素受体调节剂（SERM）形式进行的充分药物治疗。还比较了国际临床骨密度测量学会和北美更年期协会认证的骨专科医生与非骨专科医生的管理情况。
骨专科医生比非骨专科医生更有可能通过信件、电话沟通和随访门诊等形式提供咨询，并推荐负重锻炼。大多数医生，无论专科如何，都推荐补充钙和维生素D。根据NOF指南，非骨专科医生与骨专科医生在为骨量减少的绝经后女性开具药物治疗与采取保守措施方面没有显著差异，即非骨专科医生对这些女性的治疗并不比骨专科医生更不积极。
在我们的机构中，无论医生群体如何，骨量减少都得到了充分管理。然而，非骨专科医生应考虑更直接地就骨骼健康进行咨询，并考虑建议进行负重锻炼。
