不同骨密度检测标准对人群的影响以及西班牙 ESOSVAL 队列中骨密度仪的适宜性。

Impact on the population of different bone mineral density testing criteria and appropriateness of densitometries in the ESOSVAL cohort, Spain.

机构信息

Health Services Research Unit (I.H., G.S.G., C.B.P., S.P., J.S.G.), Center for Public Health Researh (CSISP-FISABIO), Valencia 46020, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (I.H., G.S.G., C.B.P., S.P., J.S.G.), Valencia 46020, Spain; and Fundación de Investigación del Hospital Clínico Universitario-Instituto de Investigación Sanitaria (J.S.G.), Valencia 46020, Spain.

出版信息

J Clin Endocrinol Metab. 2014 Jan;99(1):142-50. doi: 10.1210/jc.2013-3448.

DOI:10.1210/jc.2013-3448

PMID:24384018

Abstract

CONTEXT

There is little consensus regarding which individuals should be recommended for bone mineral density (BMD) testing, a situation that could eventually affect the appropriateness of routine clinical practice.

OBJECTIVES

The aim of this study was to estimate the impact on the population of the application of the BMD testing criteria provided by the National Osteoporosis Guideline Group (NOGG), National Osteoporosis Foundation (NOF), and Osteoporosis Canada and to assess the appropriateness of the BMD tests currently performed.

DESIGN

A cross-sectional study was conducted using the baseline data of the ESOSVAL cohort.

PARTICIPANTS

Participants included 11 035 men and women aged 50 years old and over attending primary health care centers in the Valencia region, Spain (2009-2010).

MAIN OUTCOME AND MEASURES

BMD testing by dual-energy X-ray absorptiometry was recorded.

RESULTS

Of the 10 710 people included in the study, 1617 (15.1%; 95% confidence interval [CI]: 14.4-15.8) received a BMD test. When applying the NOGG criteria, BMD testing would be recommended in 17.4% (95% CI: 16.7-18.1) of individuals, whereas this percentage would rise to 74.6% (95% CI: 73.7-75.4) and 80.1% (95% CI: 79.4-80.9) when using the Osteoporosis Canada and the NOF criteria, respectively. Regarding the appropriateness of the BMD tests performed in the ESOSVAL cohort, 40.7% (95% CI: 38.3-43.1), 86.0% (95% CI: 84.3-87.7), and 82.2% (95% CI: 80.3-84.1) of individuals having a BMD test met the NOGG, NOF, and the Canadian guidelines criteria, respectively. Of the tests performed, 40.7% would be deemed as appropriate, whereas 10.7% would be considered inappropriate.

CONCLUSIONS

The impact on the population of the different recommendations is enormous, varying from 17% to 80% of the population over 50 who would be tested. Although in men it seems that a clinical rationale exists between the presence of risk factors and the rates of BMD testing, this pattern does not seem to exist in women. One in 10 of the densitometric tests performed were inappropriate according to all the guidelines.

摘要

背景

关于哪些人应该接受骨密度（BMD）检测，目前尚未达成共识，这种情况最终可能会影响常规临床实践的适宜性。

目的

本研究旨在评估应用国家骨质疏松症指南组（NOGG）、国家骨质疏松症基金会（NOF）和加拿大骨质疏松症协会提供的 BMD 检测标准对人群的影响，并评估目前进行的 BMD 检测的适宜性。

设计

采用 ESOSVAL 队列的基线数据进行横断面研究。

参与者

参与者为西班牙巴伦西亚地区参加初级保健中心的 11035 名 50 岁及以上的男性和女性（2009-2010 年）。

主要观察指标和测量方法

记录双能 X 射线吸收法的 BMD 检测情况。

结果

在纳入的 10710 人中，1617 人（15.1%；95%置信区间[CI]：14.4-15.8）接受了 BMD 检测。应用 NOGG 标准时，17.4%（95% CI：16.7-18.1）的个体将被建议进行 BMD 检测，而当使用加拿大骨质疏松症和 NOF 标准时，这一比例将分别上升至 74.6%（95% CI：73.7-75.4）和 80.1%（95% CI：79.4-80.9）。关于 ESOSVAL 队列中进行的 BMD 检测的适宜性，40.7%（95% CI：38.3-43.1）、86.0%（95% CI：84.3-87.7）和 82.2%（95% CI：80.3-84.1）的个体符合 NOGG、NOF 和加拿大指南标准。在接受 BMD 检测的个体中，40.7%的检测被认为是适宜的，而 10.7%的检测被认为是不适宜的。