摘要：Objectives. This study explored the recognition and treatment of osteoporosis and vertebral fracture among older women by primary care physicians. Methods. Data from the National Ambulatory Medical Care Survey from 1993 to 1997 were examined for evidence of diagnosis and treatment of osteoporosis or vertebral fracture during visits by White women 60 years and older to primary care physicians. Results. Fewer than 2% of the women received diagnoses of osteoporosis or vertebral fracture, although expected prevalence is 20% to 30%. Appropriate drug treatment, including antiresorptive agents and calcium and vitamin D, was offered to only 36% of the diagnosed patients. Conclusions. Few cases of osteoporosis or vertebral fracture in older women are being diagnosed and treated by primary care physicians. Many older US women are at risk for osteoporosis-related fractures. Of the women 65 years and older, 29% have osteoporosis by bone mineral density determinations, 1 and 20% to 30% already have at least 1 osteoporosis-related vertebral fracture, 2– 4 placing them at high risk for future fractures 5– 8 and associated mortality and disability. 4, 9, 10 Recent advances in medical treatment, including several bisphosphonates, a selective estrogen receptor modulator, and nasal calcitonin spray, can reduce the risk of fracture. 6, 11– 17 Estrogen replacement and calcium supplementation have been confirmed as effective strategies for reducing bone loss. 18– 22 Despite the availability and efficacy of these agents, however, recognition and appropriate treatment of osteoporosis by clinicians appear less than ideal. Only 5% of the women who had osteoporosis diagnosed by bone mineral density determinations were told by a physician that they had “osteoporosis . . . thin or brittle bones.” 1 Of the older women hospitalized at a regional medical center who had radiographically demonstrated vertebral fractures, only 17% had these noted in medical records, and only 30% of those identified had appropriate treatment recorded. 23 This study examined recognition and treatment of osteoporosis by a national sample of primary care physicians who treat older women and determined the rate of prescribing appropriate medications for osteoporosis.
