Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
J Hand Surg Am. 2020 Feb;45(2):153.e1-153.e5. doi: 10.1016/j.jhsa.2019.01.018. Epub 2019 Mar 22.
Despite the high prevalence, morbidity, and treatment costs for osteoporosis-related fractures, studies have shown that patients infrequently receive the recommended treatment for low bone density (LBD). This study investigated patient perceptions about evaluation, management, and willingness to pursue osteoporosis treatment to further elucidate potential barriers to LBD treatment.
A survey was prospectively administered to patients over 50 years old addressing patient history of fragility fractures and osteoporosis evaluation and treatment, medication administration preferences, and willingness to start a new medication to treat or prevent future fragility fractures.
Three hundred twenty-five patients completed surveys (63.1% women, 36.9% men; mean age, 64.1 years). Patients reported the following: 50.8% had taken supplements or medication for LBD. Patients who had never taken LBD prescription medications were asked about their willingness to take these medications if physician-recommended. The mean response on a 0 to 10 scale was 7.3 ± 3.2, which was not significantly different between fracture or bone density subgroups. Several barriers to taking LBD medications were identified: 85.7% said no medical provider had prescribed them; 14.0% stated they already took too many medications; 10.4% were afraid of potential side effects; 4.3% had conflicting provider recommendations; and 1.8% cited financial concerns.
Patients held a favorable opinion on taking LBD medications when prescribed. Although 29.8% of patients had an abnormal dual-energy x-ray absorptiometry (DEXA) result, 85.7% of all patients reported that no medical provider had prescribed LBD medications. A sizeable gap remains between current practice and optimal osteoporosis education and management.
Despite the large reported and increasing prevalence of osteoporosis in patients with upper extremity fragility fractures, the rate of treatment for LBD remains suboptimal.
尽管骨质疏松症相关骨折的发病率高、发病率高且治疗费用高，但研究表明，患者很少接受推荐的低骨密度（LBD）治疗。本研究调查了患者对评估、管理和接受骨质疏松症治疗的看法，以进一步阐明 LBD 治疗的潜在障碍。
前瞻性地向 50 岁以上的患者发放问卷，调查患者脆性骨折和骨质疏松症评估和治疗的病史、药物管理偏好以及开始新药物治疗以预防或治疗未来脆性骨折的意愿。
325 名患者完成了调查（63.1%为女性，36.9%为男性；平均年龄 64.1 岁）。患者报告：50.8%服用过补充剂或药物治疗 LBD。从未服用过 LBD 处方药的患者，如果医生建议，询问他们是否愿意服用这些药物。0 到 10 分的平均得分为 7.3 ± 3.2，骨折或骨密度亚组之间无显著差异。确定了服用 LBD 药物的几个障碍：85.7%的人表示没有医疗服务提供者为他们开处方；14.0%的人表示他们已经服用了太多药物；10.4%的人担心潜在的副作用；4.3%的人有相互矛盾的提供者建议；1.8%的人表示有经济方面的担忧。
当处方开具 LBD 药物时，患者对服用 LBD 药物持有利意见。尽管 29.8%的患者双能 X 线吸收法（DEXA）检查结果异常，但 85.7%的患者报告称，没有医疗服务提供者为他们开具 LBD 药物。目前的实践与最佳骨质疏松症教育和管理之间仍存在较大差距。
尽管上肢脆性骨折患者的骨质疏松症发病率高且呈上升趋势，但 LBD 的治疗率仍不理想。
