Departments of Medicine and Radiology, University of Manitoba, C5121 - 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Curr Osteoporos Rep. 2019 Dec;17(6):483-490. doi: 10.1007/s11914-019-00542-w.
Despite the high prevalence and impact of osteoporosis, screening and treatment rates remain low, with few women age 65 years and older utilizing osteoporosis screening for primary prevention.
This review examines opportunities and challenges related to primary prevention and screening for osteoporosis at the population level. Strategies on how to identify individuals at high fracture risk and target them for treatment have lagged far behind other developments in the osteoporosis field. Most osteoporosis quality improvement strategies have focused on patients with recent or prior fracture (secondary prevention), with limited attention to individuals without prior fracture. For populations without prior fracture, the only quality improvement strategy for which meta-analysis demonstrated significant improvement in osteoporosis care was patient self-scheduling of DXA plus education Much more work is needed to develop and validate effective primary screening and prevention strategies and translate these into high-quality guidelines.
尽管骨质疏松症的患病率和影响很高,但筛查和治疗率仍然很低,很少有 65 岁及以上的女性将骨质疏松症筛查用于一级预防。
本综述探讨了人群层面进行骨质疏松症一级预防和筛查的机会和挑战。关于如何识别骨折高风险个体并对其进行治疗的策略远远落后于骨质疏松症领域的其他进展。大多数骨质疏松症质量改进策略都集中在近期或既往骨折的患者(二级预防)上,而对无既往骨折的个体关注有限。对于没有既往骨折的人群,唯一经过荟萃分析证明在骨质疏松症护理方面有显著改善的质量改进策略是患者自行安排 DXA 检查加教育。还需要做更多的工作来开发和验证有效的一级筛查和预防策略,并将其转化为高质量的指南。