Eiken Pia A, Abrahamsen Bo
Kardiologisk-endokrinologisk Afdeling, Hillerød Hospital, DK-3400 Hillerød, Denmark.
Ugeskr Laeger. 2010 Mar 1;172(9):700-4.
Osteoporosis is a major cause of low-energy hip fractures. Although there are pharmacologic agents available for both prevention and treatment, less than 10% of hip fracture cases initiate anti-osteoporotic treatment.
In 1995 and 2008, questionnaires were sent to all Danish orthopaedic surgery departments treating patients with low-energy hip fractures, asking them to explain a) whether patients with osteoporosis are identified, b) whether the patients identified are treated for osteoporosis, and c) whether physicians need more information about osteoporosis.
56 departments (97%) returned the questionnaires in 1995 and 25 (95%) in 2008. 40% of the departments did (12% in 1995) refer any patients with low-energy fractures to bone densitometry. 84% treated (11% in 1995) patients with hip fractures with calcium and D vitamin. In 2008, 28% (0% in 1995) of the departments used bisfosfonates after hip fractures (none used yearly zoledronate). More than 80% (54% in 1995) of the departments informed the patients about in the advantages of lifestyle changes. Half of the departments' doctors wanted more information about osteoporosis in 1995 compared with only 16% in 2008. In 2008, 48% of the departments informed the GPs that their patient with a low-energy fracture may have osteoporosis and that further evaluation and treatment may be needed.
Medical treatment after fractures was more widespread in 2008 than in 1995. About half of the Danish departments with orthopaedic surgery functions refer patients to further investigation. There is, however, still room for improvement.
骨质疏松症是低能量髋部骨折的主要原因。尽管有用于预防和治疗的药物,但不到10%的髋部骨折病例开始接受抗骨质疏松治疗。
1995年和2008年,向丹麦所有治疗低能量髋部骨折患者的骨科手术科室发送问卷,要求他们说明:a)是否识别出骨质疏松症患者;b)识别出的患者是否接受骨质疏松症治疗;c)医生是否需要更多关于骨质疏松症的信息。
1995年有56个科室(97%)回复了问卷,2008年有25个科室(95%)回复。40%的科室(1995年为12%)将任何低能量骨折患者转诊进行骨密度测定。84%的科室(1995年为11%)用钙和维生素D治疗髋部骨折患者。2008年,28%的科室(1995年为0%)在髋部骨折后使用双膦酸盐(无人使用每年一次的唑来膦酸)。超过80%的科室(1995年为54%)告知患者生活方式改变的益处。1995年,一半的科室医生希望获得更多关于骨质疏松症的信息,而2008年这一比例仅为16%。2008年,48%的科室告知全科医生,他们的低能量骨折患者可能患有骨质疏松症,可能需要进一步评估和治疗。
2008年骨折后的药物治疗比1995年更为普遍。约一半具有骨科手术功能的丹麦科室将患者转诊进行进一步检查。然而,仍有改进空间。