University of Manitoba, Winnipeg, Canada.
Ann Intern Med. 2010 Nov 2;153(9):580-6. doi: 10.7326/0003-4819-153-9-201011020-00007.
Several national organizations recommend that fracture risk assessment and osteoporotic treatment be based on estimated absolute 10-year fracture risk rather than bone mineral density (BMD) alone.
To assess the changes in physician prescribing behavior after introduction of absolute 10-year fracture risk reporting.
Before-and-after study.
Manitoba, Canada, which has an integrated BMD program in which tests are linkable to a population-based administrative health database repository.
Women 50 years or older who were not receiving osteoporosis medication (2042 before and 3889 after intervention).
Introduction of a system reporting absolute 10-year fracture risk along with dual-energy x-ray absorptiometry results.
The proportion of untreated women who were prescribed osteoporosis medications in the year after baseline BMD measurement.
Absolute fracture risk reporting reclassified more women (32.7%) into lower-risk categories than into higher-risk categories (10%). This effect was more prominent in women younger than 65 years. Fewer women per physician were prescribed osteoporosis drugs after introduction of absolute fracture risk reporting. The absolute fracture risk reporting system was associated with an overall reduction in osteoporosis medications dispensed (adjusted absolute reduction, 9.0 percentage points [95% CI, 3.9 to 14.2 percentage points]; relative reduction, 21.3% [CI, 9.2% to 33.5%]; P < 0.001). The reduction was attributed to fewer drugs dispensed to women at low and moderate risk for fracture. No differences in fracture rates were observed.
This was a nonrandomized study. The risk assessment system studied differs slightly from other 10-year fracture risk assessment models.
Change from a T-score-based fracture risk reporting system to a system based on absolute 10-year fracture risk was associated with appropriate, guideline-based changes in prescription of osteoporosis medications.
None.
一些国家组织建议，骨折风险评估和骨质疏松治疗应基于估计的 10 年绝对骨折风险，而不仅仅是骨密度（BMD）。
评估在引入绝对 10 年骨折风险报告后，医生处方行为的变化。
前后研究。
加拿大马尼托巴省，该省拥有一个综合的 BMD 计划，其中测试与基于人群的行政健康数据库存储库相关联。
年龄在 50 岁及以上、未接受骨质疏松症药物治疗的女性（干预前 2042 例，干预后 3889 例）。
引入报告绝对 10 年骨折风险和双能 X 射线吸收法结果的系统。
在基线 BMD 测量后的一年中，未经治疗的女性中被开处骨质疏松症药物的比例。
绝对骨折风险报告将更多的女性（32.7%）重新分类为低风险类别，而不是高风险类别（10%）。这种影响在 65 岁以下的女性中更为明显。在引入绝对骨折风险报告后，每个医生开处骨质疏松症药物的女性人数减少。绝对骨折风险报告系统与骨质疏松症药物配给总量减少相关（调整后的绝对减少 9.0 个百分点[95%CI，3.9 至 14.2 个百分点]；相对减少 21.3%[CI，9.2%至 33.5%]；P < 0.001）。减少归因于低风险和中度骨折风险的女性开处的药物减少。未观察到骨折率的差异。
这是一项非随机研究。所研究的风险评估系统与其他 10 年骨折风险评估模型略有不同。
从基于 T 评分的骨折风险报告系统向基于 10 年绝对骨折风险的系统转变与骨质疏松症药物处方的适当、基于指南的变化相关。
无。
