Buckley L M, Marquez M, Hudson J O, Downs R W, Vacek P, Small R E, Poses R
Medical College of Virginia Campus of Virginia Commonwealth University, Richmond 23298, USA.
J Rheumatol. 1998 Nov;25(11):2195-202.
Longterm corticosteroid use is associated with an increased risk of osteoporosis and fractures. Calcium and vitamin D supplementation and estrogen replacement therapy can decrease this risk, but the majority of patients receiving longterm corticosteroid treatment do not receive treatments to prevent bone loss. We assess whether this is due to variations in physicians' judgments about risks and efficacy of treatments to prevent corticosteroid-induced osteoporosis.
Questionnaires were mailed to 425 physicians, who were sampled so that half were generalists and half were specialists. Physicians were given hypothetical clinical scenarios involving patients taking corticosteroids and asked to judge the importance of osteoporosis as a risk of corticosteroid treatment, the importance of discussing this side effect with patients, and to indicate how often they would use calcium with vitamin D and estrogen for a hypothetical postmenopausal patient receiving longterm corticosteroid treatment.
In total 198 physicians (50%) responded to this survey. Most physicians rated osteoporosis as one of the 3 most significant side effects of corticosteroid treatment for postmenopausal women, but there was significant variation in physician judgments about the importance of corticosteroid induced osteoporosis for premenopausal women (p=0.03) and men (p=0.001). There was also significant variation in physician judgments about the importance of discussing osteoporosis as a side effect with patients (p=0.001), and their use of both calcium and vitamin D (p=0.002) and estrogen replacement therapy (p=0.001) for a hypothetical postmenopausal patient. The physician characteristics most associated with these differences were physician specialty and experience with corticosteroid use. Primary care physicians and physicians who more commonly prescribe corticosteroids were more likely to report that they would use estrogen and calcium to prevent corticosteroid induced bone loss. Physician age, sex, and university affiliation had no association with physician assessments.
Physicians' judgments varied significantly by physician specialty and experience with corticosteroid use. These data suggest that patients cared for by physicians in different specialties will get varying advice about osteoporosis risk and preventive treatments when receiving longterm corticosteroid treatment.
长期使用皮质类固醇与骨质疏松症及骨折风险增加相关。补充钙和维生素D以及雌激素替代疗法可降低此风险，但大多数接受长期皮质类固醇治疗的患者未接受预防骨质流失的治疗。我们评估这是否是由于医生对预防皮质类固醇诱导的骨质疏松症治疗的风险和疗效判断存在差异。
向425名医生邮寄问卷，抽样时确保一半为全科医生，一半为专科医生。医生们收到涉及服用皮质类固醇患者的假设临床场景，并被要求判断骨质疏松症作为皮质类固醇治疗风险的重要性、与患者讨论此副作用的重要性，并指出对于假设接受长期皮质类固醇治疗的绝经后患者，他们会多频繁地使用钙加维生素D和雌激素。
共有198名医生（50%）回复了此调查。大多数医生将骨质疏松症列为绝经后女性皮质类固醇治疗最显著的三种副作用之一，但医生对绝经前女性（p = 0.03）和男性（p = 0.001）皮质类固醇诱导的骨质疏松症重要性的判断存在显著差异。医生对将骨质疏松症作为副作用与患者讨论的重要性的判断（p = 0.001），以及他们对假设绝经后患者使用钙和维生素D（p = 0.002）和雌激素替代疗法（p = 0.001）的情况也存在显著差异。与这些差异最相关的医生特征是医生专业和使用皮质类固醇的经验。初级保健医生和更常开具皮质类固醇的医生更有可能报告他们会使用雌激素和钙来预防皮质类固醇诱导的骨质流失。医生的年龄、性别和大学附属机构与医生评估无关。
医生们的判断因医生专业和使用皮质类固醇的经验而有显著差异。这些数据表明，接受长期皮质类固醇治疗时，由不同专科医生护理的患者将获得关于骨质疏松症风险和预防治疗的不同建议。
