Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
Osteoporos Int. 2010 Sep;21(9):1471-85. doi: 10.1007/s00198-009-1116-6. Epub 2009 Nov 25.
Attendance at a fragility-fractures-prevention workshop by primary care physicians was associated with higher rates of osteoporosis screening and treatment initiation in elderly female patients and higher rates of treatment initiation in high-risk male and female patients. However, osteoporosis management remained sub-optimal, particularly in men.
Rates of osteoporosis-related medical practices of primary care physicians exposed to a fragility-fractures-prevention workshop were compared with those of unexposed physicians.
In a cluster cohort study, 26 physicians exposed to a workshop were matched with 260 unexposed physicians by sex and year of graduation. For each physician, rates of bone mineral density (BMD) testing and osteoporosis treatment initiation among his/her elderly patients 1 year following the workshop were computed. Rates were compared using multilevel logistic regression models controlling for potential patient- and physician-level confounders.
Twenty-five exposed physicians (1,124 patients) and 209 unexposed physicians (9,663 patients) followed at least one eligible patient. In women, followed by exposed physicians, higher rates of BMD testing [8.5% versus 4.2%, adjusted OR (aOR) = 2.81, 95% CI 1.60-4.94] and treatment initiation with bone-specific drugs (BSDs; 4.8% vs. 2.4%, aOR = 1.95, 1.06-3.60) were observed. In men, no differences were detected. In patients on long-term glucocorticoid therapy or with a previous osteoporotic fracture, higher rates of treatment initiation with BSDs were observed in women (12.0% vs. 1.9%, aOR = 7.38, 1.55-35.26), and men were more likely to initiate calcium/vitamin D (5.3% vs. 0.8%, aOR = 7.14, 1.16-44.06).
Attendance at a primary care physician workshop was associated with higher rates of osteoporosis medical practices for elderly women and high-risk men and women. However, osteoporosis detection and treatment remained sub-optimal, particularly in men.
初级保健医生参加脆性骨折预防研讨会与老年女性骨质疏松症筛查和治疗起始率较高以及高危男性和女性患者治疗起始率较高相关。然而，骨质疏松症管理仍然不理想，尤其是在男性中。
比较了接触脆性骨折预防研讨会的初级保健医生与未接触的医生的骨质疏松相关医疗实践率。
在一项聚类队列研究中，26 名参加研讨会的医生与 260 名未参加研讨会的医生按性别和毕业年份进行匹配。对于每位医生，在研讨会后 1 年，计算其老年患者的骨密度（BMD）检测和骨质疏松症治疗起始率。使用多水平逻辑回归模型控制潜在的患者和医生水平混杂因素比较率。
25 名接触过医生（1124 名患者）和 209 名未接触过医生（9663 名患者）随访了至少一名合格患者。在女性中，与接触过医生的患者相比，BMD 检测率更高[8.5%对 4.2%，调整后的 OR（aOR）=2.81，95%CI 1.60-4.94]和骨特异性药物（BSD）治疗起始率更高[4.8%对 2.4%，aOR=1.95，1.06-3.60]。在男性中，未发现差异。在长期接受糖皮质激素治疗或有既往骨质疏松性骨折的患者中，女性 BSD 治疗起始率更高[12.0%对 1.9%，aOR=7.38，1.55-35.26]，男性更有可能开始钙/维生素 D 治疗[5.3%对 0.8%，aOR=7.14，1.16-44.06]。
初级保健医生参加研讨会与老年女性和高危男性和女性骨质疏松症医疗实践率较高相关。然而，骨质疏松症的发现和治疗仍然不理想，尤其是在男性中。
