Pradhan Anup Bahadur, Nicholls Elaine, Edwards John James, Welsh Victoria, Paskins Zoe
School of Medicine, David Weatherall Building, Keele University, Keele, UK
Belvidere Medical Practice, Shrewsbury, UK.
BJGP Open. 2024 Apr 25;8(1). doi: 10.3399/BJGPO.2023.0084. Print 2024 Apr.
Lifetime risk of fragility fractures is 50% in post-menopausal women and 20% in men aged >50 years. Identifying people at high risk facilitates early intervention and reduction of biopsychosocial morbidity associated with these fractures.
To explore if bone health assessment (BHA) rates differ between women and men aged ≥50 years with fragility fracture risk factors.
DESIGN & SETTING: A primary care-based cohort study in North Staffordshire, UK.
Patients were identified from the Consultations in Primary Care Archive (CiPCA) database between 2002 and 2014 with one or more fragility fracture risk factors (previous fractures, falls, and prolonged steroid use). Evaluation of BHA within 12 months of presentation of the first risk factor was carried out by searching for codes for fracture risk assessment tools (FRAX and QFracture), bone density measurement, specialist service referral, or if bone-protection medication was started.
A total of 15 581 patients with risk factors were identified; men represented 40.4% of the cohort. The study found 1172 (7.5%) had BHA performed within 1 year of presentation, and 8.9% of women and 5.5% of men had BHAs, which was found with strong statistical evidence (χ = 59.88, = 1 × 10). This relationship prevailed after adjusting for other covariates, such as comorbidity and number of consultations, with an odds ratio of 1.25 (95% confidence interval [CI] = 1.08 to 1.43).
This study has shown that rates of BHA were generally low and even lower in men compared with women. Primary care clinicians should be alert to fragility fracture risk factors in both men and women to enable early assessment and intervention.
绝经后女性发生脆性骨折的终生风险为50%，50岁以上男性为20%。识别高危人群有助于早期干预并降低与这些骨折相关的生物心理社会发病率。
探讨≥50岁有脆性骨折风险因素的男性和女性之间的骨健康评估（BHA）率是否存在差异。
英国北斯塔福德郡一项基于初级保健的队列研究。
从2002年至2014年的初级保健档案咨询（CiPCA）数据库中识别出有一个或多个脆性骨折风险因素（既往骨折、跌倒和长期使用类固醇）的患者。通过搜索骨折风险评估工具（FRAX和QFracture）、骨密度测量、专科服务转诊的代码，或是否开始使用骨保护药物，对首次出现风险因素后12个月内的BHA进行评估。
共识别出15581名有风险因素的患者；男性占队列的40.4%。研究发现，1172名（7.5%）患者在出现症状后1年内进行了BHA，其中8.9%的女性和5.5%的男性进行了BHA，有强有力的统计学证据（χ = 59.88， = 1 × 10）。在调整其他协变量（如合并症和会诊次数）后，这种关系依然存在，优势比为1.25（95%置信区间[CI] = 1.08至1.43）。
本研究表明，BHA率普遍较低，男性比女性更低。初级保健临床医生应警惕男性和女性的脆性骨折风险因素，以便进行早期评估和干预。
