Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
Osteoporos Int. 2017 Dec;28(12):3401-3406. doi: 10.1007/s00198-017-4206-x. Epub 2017 Sep 10.
We evaluated gender imbalance in osteoporosis management in a provincial coordinator-based fracture prevention program and found no difference by gender in treatment of high-risk fragility fracture patients. This establishes that a systemic approach with interventions for all fragility fracture patients can eliminate the gender inequity that is often observed.
The purpose of this study was to evaluate an Ontario-based fracture prevention program for its ability to address the well-documented gender imbalance in osteoporosis (OP) management, by incorporating its integrated fracture risk assessments within a needs-based evaluation of equity.
Fragility fracture patients (≥ 50 years) who were treatment naïve at screening and completed follow-up within 6 months of screening were studied. Patients who underwent bone mineral density (BMD) testing done in the year prior to their current fracture were excluded. All participants had BMD testing conducted through the Ontario OP Strategy Fracture Screening and Prevention program, thus providing us with fracture risk assessment data. Our primary study outcome was treatment initiation at follow-up within 6 months of screening. Gender differences were compared using Fisher's exact test, at p < 0.05.
After adjusting for subsequent fracture risk, study participants did not show a statistically significant gender difference in pharmacotherapy initiation at follow-up (p > 0.05). 68.4% of women and 66.2% of men at high risk were treated within 6 months of screening.
Needs-based analyses show no difference by gender in treatment of high-risk fragility fracture patients. An intensive coordinator-based fracture prevention model adopted in Ontario, Canada was not associated with gender inequity in OP treatment of fragility fracture patients after fracture risk adjustment.
本研究旨在通过整合脆性骨折患者的骨折风险评估，在基于需求的公平性评估中，评估安大略省基于省级协调员的骨折预防计划在解决骨质疏松症（OP）管理中众所周知的性别失衡问题方面的能力。
筛选时对治疗药物无使用经验且在筛选后 6 个月内完成随访的脆性骨折患者（≥50 岁）被纳入研究。排除在当前骨折前一年接受过骨密度（BMD）检测的患者。所有参与者均通过安大略省 OP 策略骨折筛查和预防计划进行 BMD 检测，从而为我们提供了骨折风险评估数据。我们的主要研究结果是在筛选后 6 个月的随访中开始治疗。使用 Fisher 精确检验比较性别差异，p<0.05 为差异有统计学意义。
在调整了随后的骨折风险后，研究参与者在随访时开始药物治疗的性别差异无统计学意义（p>0.05）。在高风险的女性和男性中，有 68.4%和 66.2%的患者在筛选后 6 个月内接受了治疗。
基于需求的分析表明，在治疗高风险脆性骨折患者方面，性别差异无统计学意义。在加拿大安大略省采用的基于密集协调员的骨折预防模式，在调整骨折风险后，与 OP 治疗脆性骨折患者的性别不平等无关。
