Osteoporosis Screening, Prevention, and Treatment in Systemic Lupus Erythematosus: Application of the Systemic Lupus Erythematosus Quality Indicators
Osteoporosis Screening, Prevention, and Treatment in Systemic Lupus Erythematosus: Application of the Systemic Lupus Erythematosus Quality Indicators
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DOI：
10.1002/acr.20150
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发表时间：
2010-07-01
影响因子：
4.7
通讯作者：
Yazdany, Jinoos
中科院分区：
文献类型：
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作者：
Schmajuk, Gabriela;Yelin, Edward;Yazdany, Jinoos
Objective.骨质疏松和脆性骨折与系统性红斑狼疮（SLE）患者的显著发病率相关。SLE的新质量指标（QIs）建议骨密度检测、钙和维生素D的使用以及接受高剂量类固醇的特定亚组患者的抗吸收或合成代谢治疗。受试者是加州大学旧金山弗朗西斯科狼疮结局研究的参与者，该研究是2007-2008年对经医生确诊的SLE患者进行的一项正在进行的纵向研究。患者回答了年度电话调查，并询问人口统计学，临床和其他卫生保健相关的变量。使用多元逻辑回归来预测根据上述QIs接受护理。127名患者符合QI I（筛查）和QI II（钙和维生素D）分母的正式定义标准; 91名患者符合QI III（治疗）的正式标准。对于QIs I、II和III，接受与QIs一致的护理的患者比例分别为74%、58%和56%。在所有类固醇使用者的敏感性分析中（QI I和II组n = 427，QI III组n = 224），发生率略低。接受护理的预测因素因QI和分母而异;然而，女性、年龄较大、白色人种和病程较长与高质量的护理相关。在这个以社区为基础的SLE患者队列中，骨健康相关护理是次优的。质量改进的努力应解决骨质疏松症的预防和照顾所有SLE患者，特别是那些接受高剂量，长期类固醇。
Objective. Osteoporosis and fragility fractures are associated with significant morbidity for patients with systemic lupus erythematosus (SLE). New quality indicators (QIs) for SLE advise bone mineral density testing, calcium and vitamin D use, and antiresorptive or anabolic treatment for specific subgroups of patients receiving high-dose steroids.Methods. Subjects were participants in the University of California, San Francisco Lupus Outcomes Study, an ongoing longitudinal study of patients with physician-confirmed SLE, in 2007-2008. Patients responded to an annual telephone survey and were queried regarding demographic, clinical, and other health care-related variables. Multiple logistic regression was used to predict receipt of care per the QIs described above.Results. One hundred twenty-seven patients met the criteria for the formal definitions of the denominators for QI I ( screening) and QI II ( calcium and vitamin D); 91 met the formal criteria for QI III ( treatment). The proportions of patients receiving care consistent with the QIs were 74%, 58%, and 56% for QIs I, II, and III, respectively. In a sensitivity analysis of all steroid users (n = 427 for QI I and II and n = 224 for QI III), rates were slightly lower. Predictors of receiving care varied by QI and by denominator; however, female sex, older age, white race, and longer disease duration were associated with higher-quality care.Conclusion. Bone health-related care in this community-based cohort of SLE patients is suboptimal. Quality improvement efforts should address osteoporosis prevention and care among all SLE patients, especially those receiving high-dose, prolonged steroids.