Department of Orthopedic Surgery, Ochsner Medical Center, LA, USA.
Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL.
J Clin Densitom. 2022 Jul-Sep;25(3):424-431. doi: 10.1016/j.jocd.2021.09.002. Epub 2021 Sep 26.
Despite the burden of osteoporosis-related fractures and availability of effective treatment, a substantial osteoporosis care gap persists. We evaluated this gap following fragility hip fracture, testing the hypothesis that patients who live in areas with low health care access or quality are less likely to undergo evaluation or treatment following hip fragility fracture. This retrospective analysis quantified osteoporosis evaluation and treatment just prior and for 12 mo following fragility hip fracture at an academic medical center in the upper Midwest. Initiation of pharmacologic therapy, Vitamin D screening and dual energy X-ray absorptiometry (DXA) scanning were measured. Each patient was assigned a value for 3 metrics of regional healthcare access and quality: (1) population per PCP ratio, (2) percent un-insured <65 yrs old, and (3) preventable hospitalization >65 yrs old. Generalized estimating equations, with county as a random effect, were used to assess the association of patient characteristics and/or heath care metrics with osteoporosis treatment at the time of admission and/or osteoporosis evaluation and treatment during hospitalization and post-discharge. A total of 585 patients were 80.7 ± 8.4 yrs of age at the time of hip fragility fracture; 68% were women. In 12 mo post-fracture, 17% underwent vitamin D screening, 12% received a DXA scan and 17% began a new bone anti-resorptive medication. Only in-hospital Vitamin D screening was more common in patients from counties with low healthcare access; all other pre- and post-fracture care was more common for patients with greater healthcare access and quality. Overall rates of initiating pharmacologic treatment and/or obtaining a Vitamin D screen or DXA scan following hip fragility fracture were very low and were worse in patients from counties with low access and quality of healthcare. These results remind the practitioner to diagnose and treat osteoporosis following hip fracture and suggests a role for targeting high-risk groups.
尽管骨质疏松症相关骨折的负担以及有效的治疗方法已经存在，但骨质疏松症的护理差距仍然很大。我们评估了髋部脆性骨折后的这种差距，假设生活在医疗保健可及性或质量较低地区的患者在髋部脆性骨折后不太可能接受评估或治疗。这项回顾性分析在中西部一所学术医疗中心量化了髋部脆性骨折前后 12 个月的骨质疏松症评估和治疗情况。测定了药物治疗、维生素 D 筛查和双能 X 线吸收法（DXA）扫描的启动情况。每位患者都有 3 个区域医疗保健可及性和质量指标的值：（1）每 PCP 比例的人口，（2）65 岁以下未参保人数百分比，（3）65 岁以上可预防住院人数百分比。使用广义估计方程，以县为随机效应，评估患者特征和/或医疗保健指标与入院时骨质疏松症治疗以及住院期间和出院后骨质疏松症评估和治疗的相关性。共 585 名患者髋部脆性骨折时年龄为 80.7 ± 8.4 岁；68%为女性。在骨折后 12 个月，17%接受了维生素 D 筛查，12%接受了 DXA 扫描，17%开始使用新的抗骨吸收药物。只有住院期间的维生素 D 筛查在医疗保健可及性较低的县更为常见；所有其他骨折前和骨折后的护理在医疗保健可及性和质量较高的患者中更为常见。髋部脆性骨折后开始药物治疗和/或接受维生素 D 筛查或 DXA 扫描的总体比率非常低，在医疗保健可及性和质量较低的县的患者中更差。这些结果提醒医生在髋部骨折后诊断和治疗骨质疏松症，并表明针对高风险人群的作用。
