Düşük ve yüksek enerjili kırık sonrası kemik mineral yoğunluk testi ve osteoporoz tedavisinin prevalansı

Öz

Amaç: Bu çalışmanın amacı kırık sonrası kemik mineral yoğunluğu (KMY) testi ve düşük enerjili veya yüksek enerjili kırıklar için ortopedi servisine başvuran hastalarda osteoporoz tedavisi prevalansını rapor etmek ve kırık sonrası KMY testi ve osteoporoz tedavisi prevalansını etkileyen faktörleri belirlemek idi. Çalışma planı: Çalışmamızda, Ocak 2010 ve Mayıs 2011 tarihleri arasında düşük enerjili veya yüksek enerjili kırık ile başvuran 45 yaş ve üzeri 265 hasta incelendi. Yaş, cinsiyet, kırık bölgesi ve tedavi eden ortopedistlerin deneyimlerini de dahil olmak üzere (genç: <10, kıdemli: >10 yıl deneyimli) ve kırık sonrası KMY testi ve osteoporoz tedavisi öyküsü bilgileri kaydedildi. Bulgular: Toplam 265 hasta (175 kadın, 90 erkek) içinde 259 (%97.7) hastada düşük enerjili kırık varken, 6 (%2.3) hastada yüksek enerjili kırık mevcuttu. İki yüz elli dokuz düşük enerjili kırıktan, 99’una (38.2%) KMY testi uygulandı ve toplam T-skoru ortalaması -2.04±1.01 (proksimal-femur) ve -2.12±1.27 (bel-omurga) olarak belirlendi. Sadece bir yüksek enerjili kırık hastasına (%16.7) KMY testi uygulandı ve T-skoru -1.1 (proksimal-femur) ve -2.7 (bel-omurga) olarak bulundu. Seksen altı (32.5%) hasta (85 düşük enerjili kırık; 1 yüksek enerjili kırık) KMY testleri sonucunda osteopeni/osteoporoz tanısı ile kalsiyum, D vitamini ve bifosfonatlar ile tedavi edildi. Kemik mineral yoğunluk testi genç ortopedistler tarafından tedavi edilen, ortak bir kırık bölgesi bulunan (proksimal-femur, distal-radius, omurga) ya da kadın olan (p<0.05) düşük enerjili kırık hastalarında anlamlı derecede yüksek bulundu. Çıkarımlar: Kemik mineral yoğunluk inceleme ve tedavi oranları halen istenen düzeyde değildir. Yeterli bakımdaki mevcut boşluklar, özellikle 45 yaşın üzerindeki hastalarda gelecekteki kırıkların insidansını azaltmak için çok disiplinli bir girişim gerektirmektedir.

Anahtar Kelimeler

• Düşük-enerjili; yüksek-enerjili; kırık; osteporoz; tedavi.

Prevalence of bone mineral density testing and osteoporosis management following low- and high-energy fractures

Abstract

Objective: The aim of this study was to report the prevalence of post-fracture bone mineral density (BMD) testing and osteoporosis treatment in patients admitted to the orthopedic department for lowenergy or high-energy fractures and to identify factors affecting prevalence of post-fracture BMD testing and osteoporosis treatment.
Methods: A total of 265 patients aged 45 years or older admitted with low-energy or high-energy fractures were reviewed between January 2010 and May 2011. Information regarding age, gender, fracture site and history of post-fracture BMD testing and osteoporosis treatment, including data reporting experiences of attending orthopedists (young: <10, senior: >10 years of experience) were recorded.
Results: Of the 265 patients (175 female, 90 male), 259 (97.7%) patients had low-energy fractures and 6 (2.3%) suffered high-energy fractures. Of 259 low-energy fractures, 99 (38.2%) underwent BMD testing and had mean total T-scores of -2.04±1.01 (proximal-femur) and -2.12±1.27 (lumbar-spine). Only one high-energy fracture patient (16.7%) underwent BMD testing, with a T-score of -1.1 (proximal-femur) and -2.7 (lumbar-spine). Eighty-six (32.5%) patients (85 low-energy fractures; 1 highenergy fracture) with diagnosis of osteopenia/osteoporosis from BMD testing were treated with calcium, vitamin D, and bisphosphonates. Bone mineral density testing was significantly higher in lowenergy fracture patients who were treated by a young orthopedist, a common fracture site (proximalfemur, distal-radius, vertebrae) or were female (p<0.05).
Conclusion: Bone mineral density investigation and treatment rates are currently suboptimal. The current gap in adequate care necessitates multidisciplinary intervention in order to lessen the incidence of future fractures, particularly in patients over the age of 45.

Keywords

• Fracture
• high-energy
• low-energy
• management
• osteoporosis

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