Department of Medicine, University of Manitoba, C5121 409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada.
Osteoporos Int. 2012 May;23(5):1623-9. doi: 10.1007/s00198-011-1630-1. Epub 2011 Apr 8.
The post-fracture care gap has not narrowed in recent years. Following an initial improvement, rates of medication initiation have actually declined.
The current study characterizes temporal changes in post-fracture bone mineral density (BMD) testing or osteoporosis treatment initiation from 1996/1997 to 2007/2008.
A population-based administrative data repository for Manitoba, Canada was accessed to identify non-traumatic fractures in individuals aged 50 years and older. Outcomes included BMD testing or dispensation of an osteoporosis medication in the 12 months following the fracture.
Thirty thousand nine hundred and twenty (30,920) fracture events met the inclusion criteria; 15,670 affected major osteoporotic fracture sites. Based on either BMD testing or treatment initiation, intervention rates reached a maximum of only 15.5% in 2003/2004, compared with 6.3% in 1996/1997, and 13.2% in 2007/2008 (p-for-trend < 0.001). Post-fracture BMD testing increased from 0.7% in 1996/1997 to 8.9% 2007/2008 (p-for-trend < 0.001). Osteoporosis medication use increased from 6.1% in 1996/1997 to 12.3% in 2001/2002 and then progressively declined to 5.9% by 2007/2008 (p-for-trend = 0.025). Similar trends were observed when only major osteoporotic fractures were included. The initiation of BMD testing or medication varied according to age, gender, geographic region, and income.
Despite increased attention to gaps in osteoporosis management post-fracture in the last 10 years, the situation has not improved: in 2007/20008, fewer than 20% of untreated individuals with a low-trauma fracture received intervention. Novel strategies are required to disseminate and implement best practices at the point of care to reduce the risk of recurrent fractures.
近年来，骨折后护理差距并未缩小。在最初有所改善之后，药物起始率实际上有所下降。
本研究从 1996/1997 年到 2007/2008 年，描述了骨折后骨密度（BMD）检测或骨质疏松症治疗起始的时间变化。
访问了加拿大马尼托巴省的一个基于人群的行政数据存储库，以确定 50 岁及以上人群的非创伤性骨折。结果包括骨折后 12 个月内进行 BMD 检测或开处骨质疏松症药物。
30920 例骨折事件符合纳入标准；15670 例影响主要骨质疏松性骨折部位。基于 BMD 检测或治疗起始，干预率在 2003/2004 年仅达到最高的 15.5%，而在 1996/1997 年为 6.3%，在 2007/2008 年为 13.2%（p-趋势<0.001）。骨折后 BMD 检测从 1996/1997 年的 0.7%增加到 2007/2008 年的 8.9%（p-趋势<0.001）。骨质疏松症药物使用从 1996/1997 年的 6.1%增加到 2001/2002 年的 12.3%，然后逐渐下降到 2007/2008 年的 5.9%（p-趋势=0.025）。当仅包括主要骨质疏松性骨折时，也观察到类似的趋势。BMD 检测或药物的起始取决于年龄、性别、地理位置和收入。
尽管在过去 10 年中，人们越来越关注骨折后骨质疏松症管理方面的差距，但情况并未改善：2007/2008 年，不到 20%的低创伤性骨折未治疗的患者接受了干预。需要新的策略来传播和实施最佳实践，以减少再次骨折的风险。
