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

Kaynakça

1. Angthong C, Angthong W, Harnroongroj T, Harnroongroj T. A comparison of survival rates for hip fracture patients with or without subsequent osteoporotic vertebral compression fractures. Tohoku J Exp Med 2012; 226:129-35.
2. Sutipornpalangkul W, Harnroongroj T, Harnroongroj T. Intracapsular hip fractures have poorer nutritional status and more complications than trochanteric fractures: a retrospective study of 255 Thai patients. Siriraj Med J 2010;62:1-3.
3. Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD. The osteoporosis care gap in Canada. BMC Musculoskelet Disord 2004;5:11.
4. Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 2002;162:2217-22.
5. Onder G, Pedone C, Gambassi G, Landi F, Cesari M, Bernabei R; Investigators of the GIFA Study. Treatment of osteoporosis among older adults discharged from hospital in Italy. Eur J Clin Pharmacol 2001;57:599-604.
6. Schachter AK, Roberts CS, Seligson D. Occult bilateral acetabular fractures associated with high-energy trauma and osteoporosis. J Orthop Trauma 2003;17:386-9.
7. Lofthus CM, Osnes EK, Meyer HE, Kristiansen IS, Nordsletten L, Falch JA. Young patients with hip fracture: a population-based study of bone mass and risk factors for osteoporosis. Osteoporos Int 2006;17:1666-72.
8. Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002;167:S1-34.

9. Levasseur R, Sabatier JP, Guilcher C, Guaydier-Souquières G, Costentin-Pignol V, Jean-Jacques PY, et al. Medical management of patients over 50 years admitted to orthopedic surgery for low-energy fracture. Joint Bone Spine 2007;74:160-5. Khan SA, de Geus C, Holroyd B, Russell AS. Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med 2001;161:1309-12.
10. Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 2000;109:326-8.
11. Broy SB, Bohren A, Harrington T, Licata A, Shewman D. Are physicians treating osteoporosis after hip fracture? J Bone Miner Res 2000;15:S141.
12. Castel H, Bonneh DY, Sherf M, Liel Y. Awareness of osteoporosis and compliance with management guidelines in patients with newly diagnosed low-impact fractures. Osteoporos Int 2001;12:559-64.
13. Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 2004; 15:767-78.
14. Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J, et al. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med 2004;19:783-90.
15. Vanasse A, Dagenais P, Niyonsenga T, Grégoire JP, Courteau J, Hemiari A. Bone mineral density measurement and osteoporosis treatment after a fragility fracture in older adults: regional variation and determinants of use in Quebec. BMC Musculoskelet Disord 2005;6:33.
16. Suarez-Almazor M, Homik JE, Messina D, Davis P. Attitudes and beliefs of family physicians and gynecologists in relation to the prevention and treatment of osteoporosis. J Bone Miner Res 1997;12:1100-7.
17. Jaglal SB, Carroll J, Hawker G, McIsaac WJ, Jaakkimainen L, Cadarette SM, et al. How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 2003;49:462-8.
18. Juby AG, De Geus-Wenceslau CM. Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int 2002;13:205-10.
19. Papaioannou A, Wiktorowicz ME, Adachi JD, Goeree R, Papadimitropoulos E, Bedard M, et al. Mortality, independence in living and re-fracture, one year following hip fracture in Canadians. J Soc Obstet Gynaecol Can 2000;22:591-7.
20. Hajcsar EE, Hawker G, Bogoch ER. Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 2000;163:819-22.
21. Fitt NS, Mitchell SL, Cranney A, Gulenchyn K, Huang M, Tugwell P. Influence of bone densitometry results on the treatment of osteoporosis. CMAJ 2001;164:777-81.
22. Lee LT, Drake WM, Kendler DL. Intake of calcium and vitamin D in 3 Canadian long-term care facilities. J Am Diet Assoc 2002;102:244-7.