Man Yi, Pan Wei, Lu Jin, Li Sen-Yuan, Zhang Pian, Guo Jun-Zhe, Yu Shu-Fang, Zhang Bei, Xiao En, Zhang Chao, Zuo Wei, Jin He-Juan, Chen Yi, Wu Bin, Shi Xiao-En, Hong Di, Liu Xun, Gao Ying-Xu, Li Jing, Yin Lu, Xue Qing-Yun
Beijing Novartis Pharma, Beijing, China.
Department of Orthopaedics, Beijing, China.
Orthop Surg. 2016 Nov;8(4):432-439. doi: 10.1111/os.12296.
To investigate the treatment given to osteoporotic fracture patients by orthopaedists at major hospitals in China.
A 25-item quantitative questionnaire survey, categorized into five domains, including primary purpose of osteoporosis treatment, anti-osteoporosis therapy, calcium and vitamin D supplement, monitoring of osteoporosis, and knowledge of osteoporosis treatment, was designed to elicit information on orthopaedists' views on the treatment of osteoporotic fracture. A pre-survey test was conducted with a sample of 40 orthopaedic specialists to confirm the reliability and validity of the questionnaire. Each interview of the survey took approximately 15 min and did not directly involve any patients. The survey was conducted through face-to-face interviews at 119 tier 3 hospitals in 28 cities across Mainland China.
A total of 484 valid responses were received. Seven in ten respondents have ≥10 years of professional practice. While two-thirds believed that osteoporosis treatment was to prevent fractures or re-fractures, 95.0% agreed that anti-osteoporosis medication should be administered to patients with a history of fragility fractures. Three in four would prescribe anti-osteoporosis medication perioperatively. Of these, 79.0% regarded bisphosphonates as the first-line drug. Approximately 86.0% of the 21-30 years cohort chose bisphosphonates compared to 71.4% for those with ≤10 years. More of the younger (≤10 years) cohort chose calcitonin compared to their older (21-30 years) colleagues (25.7% vs 11.6%). The most commonly prescribed daily dose is 800 IU for vitamin D supplements and 600 mg/day for calcium.
Our respondents generally adhered to guidelines for the treatment and management of osteoporosis. A significant number had recommended lower dosages of vitamin D and calcium. Some differences exist between the younger cohort and their older colleagues in the prescription of pharmacological therapies. The criteria for initiating therapy should be more holistic and include other factors besides bone mineral density (BMD). Our results demonstrated that more comprehensive guidelines for osteoporosis management and a greater awareness of these guidelines by orthopaedists are needed to enable them to better manage their patients.
调查中国各大医院骨科医生对骨质疏松性骨折患者的治疗情况。
设计了一份包含25个项目的定量问卷调查，分为五个领域，包括骨质疏松症治疗的主要目的、抗骨质疏松治疗、钙和维生素D补充、骨质疏松症监测以及骨质疏松症治疗知识，以获取骨科医生对骨质疏松性骨折治疗观点的信息。对40名骨科专家进行了预调查测试，以确认问卷的可靠性和有效性。调查的每次访谈大约需要15分钟，且不直接涉及任何患者。该调查通过在中国大陆28个城市的119家三级医院进行面对面访谈来开展。
共收到484份有效回复。十分之七的受访者有≥10年的专业从业经验。虽然三分之二的人认为骨质疏松症治疗是为了预防骨折或再次骨折，但95.0%的人同意应给有脆性骨折病史的患者使用抗骨质疏松药物。四分之三的人会在围手术期开具抗骨质疏松药物。其中，79.0%的人将双膦酸盐视为一线药物。在21 - 30岁的人群中，约86.0%的人选择双膦酸盐，而从业年限≤10年的人群中这一比例为71.4%。与年长（21 - 30岁）的同事相比，更多年轻（≤10年）的人群选择降钙素（25.7%对11.6%）。维生素D补充剂最常开具的每日剂量是800国际单位，钙是600毫克/天。
我们的受访者总体上遵循骨质疏松症治疗和管理指南。相当一部分人建议使用较低剂量的维生素D和钙。在药物治疗的处方方面，年轻人群体和年长同事之间存在一些差异。启动治疗的标准应该更全面，除了骨密度（BMD）之外还应包括其他因素。我们的结果表明，需要更全面的骨质疏松症管理指南以及骨科医生对这些指南有更高的认识，以使他们能够更好地管理患者。
