1] Southeast Louisiana Veterans Health Care System, Section of Gastroenterology, Department of Internal Medicine, New Orleans, Louisiana, USA [2] Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
1] Southeast Louisiana Veterans Health Care System, Section of Gastroenterology, Department of Internal Medicine, New Orleans, Louisiana, USA [2] Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA [3] Department of Internal Medicine, University of Florida, Gainesville, Florida, USA.
Am J Gastroenterol. 2014 Apr;109(4):572-8. doi: 10.1038/ajg.2013.486. Epub 2014 Jan 28.
Ulcerative colitis (UC) is associated with an increased risk of metabolic bone disease and fragility fractures. The aim of this study was to assess the adherence to the guidelines issued by the American Gastroenterology Association (AGA) for the screening for low bone density in UC patients and to assess the benefits of dual-energy X-ray absorptiometry (DXA) screening among corticosteroid (CS)-treated UC patients.
Nationwide Veterans Affairs system (VA) data were obtained. UC patients followed up in the VA between 2001 and 2011 and the occurrence of fragility fractures were identified using International Classification of Diseases, Ninth Revision codes. Exposure to CSs was assessed using pharmacy data. DXA screening was assessed using the VA procedure database. Post DXA screening, medication use was also assessed from the pharmacy database. Cox regression analysis was performed to calculate the hazard ratio (HR) of fragility fractures among those patients who received DXA compared with those who did not.
We included 5,736 patients. Among them, 80 (1.4%) patients suffered from fragility fractures during the follow-up period. Overall adherence rate to AGA guidelines was 23%. Adherence rate was highest among postmenopausal women (48%) and lowest among men above 50 years of age (20%). UC patients who received DXA screening were more likely to be started on bisfosfonates (P<0.001), calcitonin (P<0.001), vitamin D, and calcium (P<0.001) compared with those who did not receive screening. Those who received DXA screening were half as likely (HR=0.5, 0.3-0.9, P=0.03) to develop fragility fractures as compared with those who did not receive screening. The benefits were more prominent among those with higher CS exposure.
Rates of DXA screening were low among CS-treated UC patients. Those who received DXA screening were more likely to be started on antiresorptive therapy and supplemental medications and had a 50% reduction in the risk of fragility fractures. More efforts should be directed toward raising the adherence to AGA guidelines and the awareness of DXA benefits.
溃疡性结肠炎（UC）与代谢性骨病和脆性骨折的风险增加有关。本研究旨在评估美国胃肠病学会（AGA）发布的关于 UC 患者低骨密度筛查指南的遵循情况，并评估双能 X 射线吸收法（DXA）筛查在接受皮质类固醇（CS）治疗的 UC 患者中的获益。
获取全国退伍军人事务部（VA）系统的数据。在 VA 接受随访的 2001 年至 2011 年间的 UC 患者，并使用国际疾病分类，第 9 版代码识别脆性骨折的发生。使用药房数据评估 CS 的暴露情况。使用 VA 程序数据库评估 DXA 筛查。DXA 筛查后，还从药房数据库评估药物使用情况。使用 Cox 回归分析计算接受 DXA 筛查的患者与未接受 DXA 筛查的患者发生脆性骨折的风险比（HR）。
我们纳入了 5736 名患者。其中，80 名（1.4%）患者在随访期间发生脆性骨折。总体上，AGA 指南的遵循率为 23%。在绝经后女性中，遵循率最高（48%），而在 50 岁以上男性中，遵循率最低（20%）。与未接受筛查的患者相比，接受 DXA 筛查的 UC 患者更有可能开始使用双膦酸盐（P<0.001）、降钙素（P<0.001）、维生素 D 和钙（P<0.001）。与未接受筛查的患者相比，接受 DXA 筛查的患者发生脆性骨折的风险降低了一半（HR=0.5，0.3-0.9，P=0.03）。这种获益在 CS 暴露较高的患者中更为显著。
在接受 CS 治疗的 UC 患者中，DXA 筛查的比例较低。接受 DXA 筛查的患者更有可能开始使用抗吸收治疗和补充药物，并且脆性骨折的风险降低了 50%。应加大力度提高 AGA 指南的遵循率和对 DXA 获益的认识。
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