The near absence of osteoporosis treatment in older men with fractures
The near absence of osteoporosis treatment in older men with fractures
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DOI：
10.1007/s00198-005-1950-0
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发表时间：
2005-08-01
影响因子：
4
通讯作者：
Aickin, M
中科院分区：
文献类型：
--
作者：
Feldstein, AC;Nichols, G;Aickin, M
老年男性骨质疏松性骨折的负担是显著的。我们研究的目的是：(1)确定老年男性骨质疏松相关骨折的特征；(2)确定骨质疏松的药物治疗率是否正在改善；(3)确定与治疗显著相关的患者、医疗效益和利用情况以及临床医生特征。这项回顾性队列研究评估了1998年1月1日至2001年6月30日期间在美国一家非营利性健康维护组织发生的1171名65岁及以上的骨质疏松相关骨折患者。采用多元logistic回归评估骨折前因素与骨折后6个月骨质疏松治疗的关系。主要观察指标是指数骨折后6个月内骨质疏松的药物治疗情况。受试者的平均年龄为76.7岁；3.3%诊断为骨质疏松症，15.2%诊断或用药与继发性骨质疏松症相关。只有7.1%的研究人群和16.0%的髋部或椎体骨折患者在指数骨折后接受了骨质疏松药物治疗，而且治疗率并没有随着时间的推移而提高。在多变量模型中，与药物治疗显著相关的因素包括：Charlson共病指数（比值比1.26,95%可信区间1.05-1.51）、骨质疏松症诊断（比值比8.11,95%可信区间3.08-21.3）、慢性糖皮质激素使用（比值比5.37,95%可信区间2.37-12.2）和椎体骨折（比值比16.6,95%可信区间7.8-31.4）。骨密度测量很少（n =13, 1.1%）。我们的研究结果表明，老年男性骨折患者骨质疏松症和可改变的继发原因的确定和治疗不足。合并诊断和治疗信息的信息系统可以帮助确定患者管理方面的差距。在其他情况下显示有希望的干预措施应进行评估，以改善对骨质疏松症的护理。
The burden of osteoporotic fractures in older men is significant. The objectives of our study were to: (1) characterize older men with fractures associated with osteoporosis, (2) determine if medication treatment rates for osteoporosis are improving and (3) identify patient, healthcare benefit and utilization, and clinician characteristics that are significantly associated with treatment. This retrospective cohort study assessed 1,171 men aged 65 or older with any new fracture associated with osteoporosis between 1 January 1998 and 30 June 2001 in a non-profit health maintenance organization in the United States. Multiple logistic regression was used to evaluate pre-fracture factors for their association with osteoporosis treatment in the 6-month post-fracture period. The main outcome measure was pharmacologic treatment for osteoporosis in the 6 months after the index fracture. Subjects' average age was 76.7 years; 3.3% had a diagnosis of osteoporosis and 15.2% a diagnosis or medication associated with secondary osteoporosis. Only 7.1% of the study population and 16.0% of those with a hip or vertebral fracture received a medication for osteoporosis following the index fracture, and treatment rates did not improve over time. In the multivariate model, factors significantly associated with drug treatment were a higher value on the Charlson Comorbidity Index (odds ratio 1.26, 95% confidence interval 1.05-1.51), having an osteoporosis diagnosis (odds ratio 8.11, 95% confidence interval 3.08-21.3), chronic glucocorticoid use (odds ratio 5.37, 95% confidence interval 2.37-12.2) and a vertebral fracture (odds ratio 16.6, 95% confidence interval 7.8-31.4). Bone mineral density measurement was rare ( n =13, 1.1%). Our findings suggest that there is under-ascertainment and under-treatment of osteoporosis and modifiable secondary causes in older men with fractures. Information systems merging diagnostic and treatment information can help delineate gaps in patient management. Interventions showing promise in other conditions should be evaluated to improve care for osteoporosis.