Louisiana State University Health Sciences Center School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA.
University of Toledo General Surgery Residency Program, Toledo, OH, USA.
Arch Osteoporos. 2022 Feb 12;17(1):34. doi: 10.1007/s11657-022-01076-y.
Bone mineral density screening and clinical risk factors are important to stratify individuals for increased risk of fracture. In a population with no history of fractures or baseline bone density measurement, black women were less likely to be screened than white counterparts prior to hip fracture.
To evaluate overall BMD (bone mineral density) screening rates within two years of hip fracture and to identify any disparities for osteoporosis screening or treatment in a female cohort who were eligible for screening under insurance and national recommendations.
Data were obtained from 1,109 female patients listed in the Research Action for Health Network (REACHnet) database, which consists of multiple health partner systems in Louisiana and Texas. Patients < 65 years old or with a history of hip fracture or osteoporosis diagnosis, screening or treatment more than 2 years before hip fracture were removed.
Only 223 (20.1%) females were screened within the two years prior to hip fracture. Additionally, only 23 (10%) of the screened patients received treatment, despite 187 (86.6%) patients being diagnosed with osteoporosis or osteopenia. Screening rates reached a maximum of 27.9% in the 75-80 age group, while the 90 + age group had the lowest screening rates of 12%. We found a quadratic relationship between age and screening rates, indicating that the screening rate increases in age until age 72 and then decreases starkly. After adjusting for potential confounders, we found that black patients had significantly decreased screening rates compared to white patients (adjusted OR = .454, 95% CI = .227-.908, p value = .026) which held in general and for patient ages 65-97.
Despite national recommendations, overall BMD screening rates among women prior to hip fracture are low. If individuals are not initially screened when eligible, they are less likely to ever be screened prior to fracture. Clinicians should address racial disparities by recommending more screening to otherwise healthy black patients above the age of 65. Lastly, treatment rates need to increase among those diagnosed with osteoporosis since all patients went on to hip fracture.
骨密度筛查和临床危险因素对于分层个体骨折风险增加很重要。在没有骨折或基线骨密度测量史的人群中，黑人女性在髋部骨折发生前接受筛查的可能性低于白人女性。
评估髋部骨折后两年内总体骨密度（BMD）筛查率，并确定在符合保险和国家建议进行筛查的女性队列中，骨质疏松症筛查或治疗是否存在差异。
数据来自 Research Action for Health Network（REACHnet）数据库中列出的 1109 名女性患者，该数据库由路易斯安那州和德克萨斯州的多个健康合作伙伴系统组成。排除年龄<65 岁或髋部骨折或骨质疏松症诊断史、筛查或治疗时间超过 2 年的患者。
仅有 223 名（20.1%）女性在髋部骨折前两年内接受了筛查。此外，尽管有 187 名（86.6%）患者被诊断为骨质疏松症或骨量减少，但仅有 23 名（10%）接受了治疗。筛查率在 75-80 岁年龄组达到最高的 27.9%，而 90+岁年龄组的筛查率最低，为 12%。我们发现年龄与筛查率之间存在二次关系，表明筛查率随着年龄的增长而增加，直到 72 岁，然后急剧下降。在调整了潜在的混杂因素后，我们发现与白人患者相比，黑人患者的筛查率显著降低（调整后的 OR=0.454，95%CI=0.227-0.908，p 值=0.026），这种情况在一般人群和 65-97 岁的患者中均存在。
尽管有国家建议，但女性在髋部骨折前的总体 BMD 筛查率仍然很低。如果患者在符合条件时未进行初始筛查，那么他们在骨折前进行筛查的可能性就会降低。临床医生应通过建议 65 岁以上的健康黑人患者进行更多的筛查来解决种族差异问题。最后，由于所有患者都发生了髋部骨折，因此需要增加骨质疏松症患者的治疗率。
