Sadat-Ali Mir, Al-Omran As, Al-Bakr Wi, Azam Md Quamar, Tantawy Am, Al-Othman Aa
Department Orthopedic Surgery, University of Dammam, Dammam, Saudi Arabia.
Department of Internal Medicine, College of Medicine, University of Dammam, and King Fahd Hospital of the University, AlKhobar, Saudi Arabia.
Ann Med Health Sci Res. 2014 Mar;4(2):198-201. doi: 10.4103/2141-9248.129038.
International osteoporosis foundation described severe or established osteoporosis as an osteoporotic individual with a fragility fracture. Orthopaedic surgeons frequently manage fractures, but we believe that large gaps are prevalent in the medical management of osteoporosis after fractures are fixed.
The aim of this analysis is to assess the investigations and gaps in the management of osteoporosis in patients admitted with a fragility fracture of femur at King Fahd Hospital of the University, AlKhobar, Saudi Arabia.
A retrospective analysis of all admission and discharge; medical and pharmacy records database of patients over ≥ 50 years with fragility fracture between January 2001 and December 2011. The outcome measures assessed were investigations such as serum calcium, phosphorous, alkaline phosphatase, parathormone, 25 hydroxy vitamin D (25OHD) levels and a dual energy X-ray absorptiometry (DEXA). Secondly once the fracture was fixed what medications were prescribed, calcium and vitamin D, antiresorptives and anabolic agents.
There were 207 patients admitted during the study period with an average age of 69.2 (12.1) years and 118 were females. In 169 (81.6%) patients, the fracture site was proximal femur. Vitamin D (25OHD) was requested in 31/207 (14.9%). DEXA scan was ordered in 49/207 (24.1%). A total of 78/207 (37.6%) patients received calcium and vitamin D3 and 94/207 (45.4%) either got calcium or vitamin D3. Bisphosphonates was used in 35, miacalcic nasal spray in 25 and anabolic agent teriparatide was prescribed in 21 patients. Post-fixation 126/207 (60.8%) patients did not receive any anti-osteoporotic medication. In untreated group, there were 87 males and 39 females.
The study found that in patients, who sustained a fragility fracture, confirmation of osteoporosis by DEXA was very low and ideal treatment for severe osteoporosis was given out to few patients. More efforts are needed to fill this large gap in the correct management of osteoporosis related fractures by orthopaedic surgeons.
国际骨质疏松基金会将严重或确诊的骨质疏松症定义为患有脆性骨折的骨质疏松患者。骨科医生经常处理骨折问题，但我们认为，在骨折固定后骨质疏松症的药物治疗方面存在很大差距。
本分析的目的是评估沙特阿拉伯胡拜尔法赫德国王大学医院收治的股骨脆性骨折患者骨质疏松症的检查情况及治疗差距。
对2001年1月至2011年12月期间年龄≥50岁的脆性骨折患者的所有入院和出院记录、医疗和药房记录数据库进行回顾性分析。评估的结果指标包括血清钙、磷、碱性磷酸酶、甲状旁腺激素、25羟维生素D（25OHD）水平等检查以及双能X线吸收法（DEXA）。其次，骨折固定后开具了哪些药物，如钙和维生素D、抗吸收药物和促合成代谢药物。
研究期间共收治207例患者，平均年龄69.2（12.1）岁，其中女性118例。169例（81.6%）患者的骨折部位为股骨近端。207例中有31例（14.9%）患者进行了维生素D（25OHD）检测。207例中有49例（24.1%）患者进行了DEXA扫描。207例中有78例（37.6%）患者接受了钙和维生素D3，94例（45.4%）患者单独接受了钙或维生素D3。35例患者使用了双膦酸盐，25例患者使用了密盖息鼻喷雾剂，21例患者使用了促合成代谢药物特立帕肽。骨折固定后，207例中有（60.8%）126例患者未接受任何抗骨质疏松药物治疗。在未治疗组中，男性87例，女性39例。
研究发现，在发生脆性骨折的患者中，通过DEXA确诊骨质疏松症的比例非常低，很少有患者接受严重骨质疏松症的理想治疗。骨科医生需要做出更多努力，以填补在正确处理骨质疏松相关骨折方面的这一巨大差距。
