Gong Hyun Sik, Oh Won Seok, Chung Moon Sang, Oh Joo Han, Lee Young Ho, Baek Goo Hyun
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
J Bone Joint Surg Am. 2009 Oct;91(10):2376-80. doi: 10.2106/JBJS.H.01871.
Although osteoporosis is being evaluated and treated increasingly in elderly patients with fragility fractures, some studies have suggested that physicians may be missing important opportunities, especially in patients with nonvertebral fractures. The purpose of the present study was to determine whether specialists responsible for treating fractures at various locations have different propensities for evaluating and treating osteoporosis after a fracture in female patients over the age of fifty years.
A retrospective nationwide cohort study was performed with use of data collected during 2007 by the Korean Health Insurance Review Agency, which covers 97% of the population. The incidences of fractures around the hip, spine, and wrist in female patients more than fifty years of age and the frequencies of bone density scans for osteoporosis and the use of medications for its treatment were analyzed and compared.
The database identified 31,540 hip fractures, 58,291 spine fractures, and 61,234 wrist fractures in female patients who were more than fifty years of age in Korea during 2007. Of these patients, 7095 (22.5%) with a hip fracture, 16,779 (28.8%) with a spine fracture, and 5348 (8.7%) with a wrist fracture underwent diagnostic bone density scans. Furthermore, 7060 patients (22.4%) with a hip fracture, 17,551 (30.1%) with a spine fracture, and 4594 (7.5%) with a wrist fracture were managed with at least one medication approved for the treatment of osteoporosis.
Despite a recent increase in the recognition of osteoporosis in patients with fragility fractures, our review of this national cohort indicates that patients with a wrist fracture are less likely to be evaluated and managed for osteoporosis than those with a hip or spine fracture by physicians who are responsible for treating symptomatic fractures. Additional studies and intervention programs are necessary to improve this care gap, beginning with physicians who are responsible for fracture treatment.
尽管骨质疏松症在老年脆性骨折患者中得到了越来越多的评估和治疗，但一些研究表明，医生可能错失了重要时机，尤其是在非椎体骨折患者中。本研究的目的是确定负责治疗不同部位骨折的专科医生在治疗50岁以上女性骨折后评估和治疗骨质疏松症的倾向是否存在差异。
利用韩国健康保险审查机构2007年收集的数据进行了一项全国性回顾性队列研究，该机构覆盖了97%的人口。分析并比较了50岁以上女性患者髋部、脊柱和腕部周围骨折的发生率，以及骨质疏松症骨密度扫描的频率和治疗药物的使用情况。
该数据库识别出2007年韩国50岁以上女性患者中的31,540例髋部骨折、58,291例脊柱骨折和61,234例腕部骨折。在这些患者中，7095例（22.5%）髋部骨折患者、16,779例（28.8%）脊柱骨折患者和5348例（8.7%）腕部骨折患者接受了诊断性骨密度扫描。此外，7060例（22.4%）髋部骨折患者、17,551例（30.1%）脊柱骨折患者和4594例（7.5%）腕部骨折患者接受了至少一种批准用于治疗骨质疏松症的药物治疗。
尽管近期脆性骨折患者对骨质疏松症的认识有所提高，但我们对这个全国性队列的回顾表明，与髋部或脊柱骨折患者相比，腕部骨折患者接受负责治疗有症状骨折的医生评估和治疗骨质疏松症的可能性较小。需要开展更多研究和干预项目来改善这一治疗差距，首先是负责骨折治疗的医生。
