Service de rhumatologie, hôpital Cochin, Paris, France.
Service de rhumatologie, CHU Grenoble Alpes, Hôpital Sud, Echirolles, France; AFLAR - Association Française de Lutte Anti-Rhumatismale, Paris, France.
Joint Bone Spine. 2020 Oct;87(5):467-473. doi: 10.1016/j.jbspin.2020.04.007. Epub 2020 May 5.
To describe the care trajectories of adults aged ≥50 years with fragility fractures in France.
A postal questionnaire was sent to 15,000 individuals aged ≥50 years extracted from a representative panel of the French population (METASKOPE) in April-May 2018. Respondents experiencing a single fragility fracture in the previous three years constituted the study population. Information was collected regarding diagnosis, hospitalisations, physician visits and treatment related to the fractures.
13,914 participants returned a questionnaire (92.8%), of whom 436 reported a single fragility fracture. Their mean age was 68.7±10.3 years. 11.9% of this sample had undergone bone densitometry (DXA) prior to the fracture and 11.9% had received a diagnostic of osteoporosis. Following the fracture, a further 17.4% underwent DXA and 8.5% were diagnosed with osteoporosis. 74.3% of fractures were initially managed in an emergency department and 29.6% led to immediate hospitalisation. Prior to fracture, 3.4% received a specific anti-osteoporotic treatment, 10.1% vitamin D and 6.4% calcium supplementation. After the fracture, these figures rose to 10.8%, 26.8% and 19.0% respectively. 86.2% participants made at least one follow-up visit to a physician.
The rate of DXA screening following fragility fractures in subjects over fifty is very low. Most patients with fragility fractures did not receive a diagnosis of osteoporosis. The proportion of patients treated with a specific anti-osteoporotic treatment after a fracture is low even though around half consulted their general practitioner after the fracture. Practice guidelines are thus not being adhered to in everyday clinical practice in France.
描述法国≥50 岁脆性骨折成年人的护理轨迹。
2018 年 4 月至 5 月，向从法国代表性人群抽样调查（METASKOPE）中抽取的 15000 名≥50 岁的个体邮寄调查问卷。在过去三年中经历过单一脆性骨折的受访者构成了研究人群。收集了与骨折相关的诊断、住院、就诊和治疗信息。
13914 名参与者返回了问卷（92.8%），其中 436 名报告了单一脆性骨折。他们的平均年龄为 68.7±10.3 岁。该样本中有 11.9%在骨折前进行了骨密度（DXA）检查，11.9%被诊断为骨质疏松症。骨折后，又有 17.4%接受了 DXA 检查，8.5%被诊断为骨质疏松症。74.3%的骨折最初在急诊科进行治疗，29.6%导致立即住院。骨折前，3.4%接受了特定的抗骨质疏松治疗，10.1%接受了维生素 D 补充，6.4%接受了钙补充。骨折后，这些数字分别上升至 10.8%、26.8%和 19.0%。86.2%的参与者至少进行了一次随访就诊。
五十多岁人群中，脆性骨折后进行 DXA 筛查的比例非常低。大多数脆性骨折患者未被诊断为骨质疏松症。骨折后接受特定抗骨质疏松治疗的患者比例较低，尽管大约一半的患者在骨折后咨询了他们的全科医生。因此，法国的临床实践并未遵循实践指南。
