Fragility fractures and the osteoporosis care gap: An international phenomenon

被引:267
作者
Giangregorio, L
Papaioannou, A
Cranney, A
Zytaruk, N
Adachi, JD
机构
[1] Univ Waterloo, Dept Kinesiol, Waterloo, ON N2L 3G1, Canada
[2] Toronto Rehabil Inst, Toronto, ON, Canada
[3] McMaster Univ, Dept Kinesiol, Hamilton, ON L8S 4L8, Canada
[4] McMaster Univ, Hamilton Hlth Sci, Dept Med, Hamilton, ON L8S 4L8, Canada
[5] Univ Ottawa, Dept Med, Ottawa, ON K1N 6N5, Canada
[6] Ottawa Hlth Res Inst, Dept Clin Epidemiol, Ottawa, ON, Canada
[7] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
[8] McMaster Univ, St Josephs Healthcare, Dept Med, Hamilton, ON, Canada
基金
加拿大健康研究院;
关键词
osteoporosis; fracture; diagnosis; treatment;
D O I
10.1016/j.semarthrit.2005.11.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES To describe practice patterns in the management of osteoporosis after fragility fracture. METHODS Systematic review of articles in MEDLINE, EMBASE, Cochrane, and Cl-NAHL databases (1996 to February 2005). Diagnostic outcomes included clinical osteoporosis diagnoses, laboratory tests, and bone density scans. Treatment outcomes included initiation of calcium, vitamin D, hormone replacement therapy, bisphosphonates, calcitonin, raloxifene and falls assessments. RESULTS Thirty-five studies met our inclusion criteria and demonstrated that adults who experience fragility fracture are not receiving osteoporosis management. An osteoporosis diagnosis was reported in 1 to 45% of patients with fractures; laboratory tests were ordered for 1 to 49% and 1 to 32% of patients had bone density scans. Calcium/vitamin D and pharmacological therapy was reported in 2 to 62% and 1 to 65% of patients, respectively. Osteoporosis treatment was recommended more often in women than men, and more often in patients with vertebral fractures than in patients with nonvertebral fractures. Older patients were more likely to be diagnosed with osteoporosis, but treatment was more likely in younger patients. A history of prior fracture was reported in 7 to 67% of patients. Between 1 and 22% of patients had a subsequent fracture during follow-up periods of 6 months to 5 years. Falls assessments were not often reported; when they were, they were infrequently performed. A greater proportion of patients were diagnosed/treated during follow-up studies than in studies evaluating diagnosis/treatment on discharge from acute care. CONCLUSIONS The majority of individuals who sustain fragility fractures are not receiving adequate osteoporosis management. Future research should address barriers to appropriate management and the efficacy of implementation strategies designed to close the osteoporosis care gap. RELEVANCE This article is of particular importance to health care professionals who provide care for patients with fragility fracture.
引用
收藏
页码:293 / 305
页数:13
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