Older women with fractures: Patients falling through the cracks of guideline-recommended osteoporosis screening and treatment
Older women with fractures: Patients falling through the cracks of guideline-recommended osteoporosis screening and treatment
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DOI：
10.2106/00004623-200312000-00005
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发表时间：
2003-12-01
影响因子：
5.3
通讯作者：
Herson, M
中科院分区：
文献类型：
--
作者：
Feldstein, AC;Nichols, GA;Herson, M
背景：许多老年骨折患者没有按照骨质疏松症的循证临床指南进行治疗。指南建议这些患者接受临床上明显的骨质疏松症治疗，或在适当时进行骨密度测量，然后进行治疗。本队列研究旨在进一步描述指南与实际实践之间关于老年女性骨折后骨密度测量和治疗的差距。我们的目的是为了帮助设计更有效的未来interventions.Methods：我们确定了女性成员的非营利组织的健康维护模型组织谁是50岁或以上，谁有一个新的骨折的诊断定义在研究中。我们使用行政数据库和临床电子病历，以获得人口统计学数据，诊断，药物分发的药房，和测量的骨矿物质density.Results：研究人群包括3812名妇女，平均年龄为71.3岁。不到12%的女性在骨折前被诊断为骨质疏松症; 10.7%的女性继发性骨质疏松症的风险增加，38.8%的女性因诊断或药物治疗而发生福尔斯。结果发现，46.4%的研究人群已按照临床指南的规定进行管理。按照指南规定进行管理的患者更年轻，不太可能有体重
Background: Many older patients with fractures are not managed in accordance with evidence-based clinical guidelines for osteoporosis. Guidelines recommend that these patients receive treatment for clinically apparent osteoporosis or have bone mineral density measurements followed by treatment when appropriate. This cohort study was conducted to further characterize the gap between guidelines and actual practice with regard to bone mineral density measurement and treatment of older women after a fracture. Our purpose was to aid in the design of more effective future interventions.Methods: We identified female members of a not-for-profit group-model health maintenance organization who were fifty years of age or older and who had a diagnosis of a new fracture as defined in the study. We used administrative databases and the clinical electronic medical records to obtain data on demographics, diagnoses, drugs dispensed by the pharmacy, and the measurement of bone mineral density.Results: The study population included 3812 women with an average age of 71.3 years. Fewer than 12% of the women had a diagnosis of osteoporosis prior to the index fracture; 10.7% had an increased risk for secondary osteoporosis and 38.8%, for falls because of a diagnosis or medication. It was found that 46.4% of the study population had been managed as specified by clinical guidelines. The patients who had been managed as specified by the guidelines were younger and less likely to have the risk factor of a weight of