Choksi Palak, Gay Brittany L, Reyes-Gastelum David, Haymart Megan R, Papaleontiou Maria
From the Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
From the Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan..
Endocr Pract. 2020 Nov;26(11):1237-1243. doi: 10.4158/EP-2020-0123. Epub 2020 Jun 23.
To understand osteoporosis screening practices, particularly in men, by a diverse cohort of physicians, including primary care physicians, endocrinologists, and geriatricians.
We surveyed randomly selected members of the American Academy of Family Practice, Endocrine Society, and American Geriatrics Society. Respondents were asked to rate how often they would screen for osteoporosis in four different clinical scenarios by ordering a bone density scan. Multivariable logistic regression analyses were conducted to determine factors associated with offering osteoporosis screening in men in each clinical scenario. Physicians were also asked to note factors that would lead to osteoporosis screening in men.
Response rate was 63% (359/566). While 90% respondents reported that they would always or frequently screen for osteoporosis in a 65-year-old post-menopausal woman, only 22% reported they would screen a 74-year-old man with no significant past medical history. Endocrinologists were more likely to screen a 74-year-old man compared to primary care physicians (odds ratio, 2.32; 95% confidence interval, 1.10 to 4.88). In addition to chronic steroid use (94%), history of nontraumatic fractures (88%), and androgen-deprivation therapy for prostate cancer (82%), more than half the physicians reported suppressive doses of thyroid hormone (64%) and history of falls (52%) as factors leading to screening for osteoporosis in men.
Our survey results highlight heterogeneity in osteoporosis screening in men, with underscreening in some scenarios compared to women, and identify factors that lead to screening in men. These findings can help design interventions to improve osteoporosis screening in men.
了解包括初级保健医生、内分泌科医生和老年病科医生在内的不同医生群体对骨质疏松症的筛查做法，尤其是对男性的筛查情况。
我们对美国家庭医生学会、内分泌学会和美国老年病学会随机抽取的成员进行了调查。受访者被要求对他们在四种不同临床场景下通过开具骨密度扫描来筛查骨质疏松症的频率进行评分。进行多变量逻辑回归分析以确定在每种临床场景下与对男性进行骨质疏松症筛查相关的因素。医生们还被要求指出会导致对男性进行骨质疏松症筛查的因素。
回复率为63%（359/566）。虽然90%的受访者表示他们会始终或经常对65岁的绝经后女性进行骨质疏松症筛查，但只有22%的受访者表示会对一名无重大既往病史的74岁男性进行筛查。与初级保健医生相比，内分泌科医生更有可能对一名74岁男性进行筛查（优势比，2.32；95%置信区间，1.10至4.88）。除了长期使用类固醇（94%）、非创伤性骨折病史（88%）和前列腺癌雄激素剥夺治疗（82%）外，超过一半的医生报告称甲状腺激素抑制剂量（64%）和跌倒史（52%）是导致对男性进行骨质疏松症筛查的因素。
我们的调查结果凸显了男性骨质疏松症筛查的异质性，在某些场景下与女性相比筛查不足，并确定了导致对男性进行筛查的因素。这些发现有助于设计干预措施以改善对男性的骨质疏松症筛查。
