Factors Associated with Gaps in Osteoporosis Treatment

骨质疏松性骨折对人类和经济的影响是惊人的。有过骨折史的人未来发生骨折的风险更高。以证据为基础的临床实践指南和有效的治疗方法是现成的，但在这一高危人群中并没有完全得到应用。这是一项回顾性队列研究，旨在评估老年女性骨质疏松性骨折的治疗差距，为设计未来再骨折的二级预防方案提供基础。治疗差距，根据本研究的定义，是女性没有接受骨质疏松症的药物治疗。这一差距可能是由于临床医生没有遵循指南，如果患者在骨折后6个月内没有接受骨密度筛查或骨密度筛查和适当的后续治疗。或者，如果提供治疗但不使用，则可能由于患者缺乏依从性而导致差距。主要目的是确定50-89岁女性是否既往有符合研究条件的临床骨折1)骨质疏松症治疗缺口的女性比例，以及缺口的比例是由于临床医生不遵循指南，以及缺乏患者依从性；2)治疗时间分布及患者依从性分布；3)在我们的电子数据库中，哪些患者、医疗保健提供者和医疗保健福利特征与治疗差距显著相关。主要结果是：1)提供者开始治疗，无论是否在指数骨折后6个月内分配骨质疏松药物，或通过双x线吸收仪（DXA）筛查完成骨密度，然后治疗股骨颈t评分在-2.5或以下；2)患者对治疗的依从性，指骨折后配药服用的时间百分比。这一建议意义重大，因为我们将能够利用临床数据库对患有骨质疏松症相关的任何指数骨折的妇女的大型数据集进行纵向评估。通过我们广泛的综合系统，我们可以调查与骨质疏松症筛查、治疗和治疗依从性相关的广泛因素。

The human and economic tool of osteoporotic fractures is staggering. Individuals who have had prior fractures are at increased risk of future fractures. Evidence-based clinical practice guidelines and effective treatment are readily available but incompletely utilized in this high-risk group. This is a retrospective cohort study designed to evaluate the treatment gap in older women who have had fracture associated with osteoporosis, to provide the foundation for designing in future secondary prevention programs for re-fracture. The treatment gap, as defined for this study, is that a woman does not receive pharmacologic treatment for osteoporosis. The gap may be due to clinicians not following guidelines if she either goes untreated without BMD screening, or does not receive a BMD screening and appropriate subsequent treatment, within six months of the index fracture. Or the gap may be due to the lack of patient compliance if treatment is offered but not used. The primary aims are to determine if woman aged 50-89 years with a prior study-eligible clinical fracture 1) the fraction of women with an osteoporosis treatment gap, and what fraction of the gap is due to clinicians not following the guidelines and what is fraction is due to the lack of patient compliance; 2) the distribution of treatment duration and the distribution of patient compliance; and 3) which patient, health care provider, and health care benefit characteristics available in our electronic databases are significantly associated with treatment gaps. The primary outcomes are: 1) provider initiation of treatment, whether or not within 6 months after the index fracture a pharmacologic agent for osteoporosis is dispensed, or BMD by dual x-ray absorptiometry (DXA) screening is completed followed by treatment for a femoral neck T-score at or below -2.5; and 2) for patient compliance with treatment, the percent of time after the index fracture the dispensed medication is taken. This proposal is significant because we will be able to longitudinally evaluate a large dataset of women who have had any index fractures associated with osteoporosis using clinical database. Through our extensive integrated systems we can investigate a broad range of factors for associations with osteoporosis screening, treatment, and compliance with treatment.