Avtor/Urednik		Hren, Rok; Salobir, Boštjan; Breznik, Mateja; Kocijančič, Andreja
Naslov		Predlog racionalnega presejanja osteoporoze v osnovnem zdravstvu
Prevedeni naslov		Proposal of rational screening for osteoporosis in the primary care
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 71, št. Suppl 1
Leto izdaje		2002
Obseg		str. I-45-8
Jezik		slo
Abstrakt		Background. Early identification of postmenopausal women with osteoporosis by means of bone mineral density (BMD) measurement is a prerequisite for reducing the incidence of osteoporotic fractures. Primary care physicians have a leading role in referring such patients, however, given the cost of the BMD measurement, efficient screening criteria remain to be determined. Currently available criteria (e. g., SCORE, ORAI) are very broad with low specificity. Objective of our study is to assess simple decision rules that could enhance identifying patients with high risk of fracture while concurrently minimizing number of unnecessary measurements. Methods. In the study, 357 primary care physicians (GPs and gynecologists) referred their patients to BMD measurements based on the following decision rules women (i) should be postmenopausal for at least 5 years, (ii) should have body mass index (BMI) less than 26 kg/m2 and (iii) should have never been diagnosed with osteoporosis. BMD of lumbarspine and/ or hip was measured by dual-energy x-ray absorptiometry (DXA) in 5 centers using Hologic (Hologic Corp., Bedford, MA) or Lunar (Lunar Corp., Madisom, WI) densitometers. Results of BMD measurements were expressed in terms of the T-score and were forwarded to the primary care physicians. Results. 2339 postmenopausal women participated in the study; by the end of the study, 327 physicians (92%) reported results on 2196 women (94%). 1332 women of 2196 (61%) were identified as osteoporotic, 637 (29%) as osteopenic, and 227 (10%) had normal BMD. Approximately 30% of patients with osteoporosis suffered from previous low-trauma fracture. Among all women, the prevalence of osteoporosis was 34% for ages less than 55 years, 50% for ages 55-59 years, and 69% for ages above 60 years. The number of DXA measurements needed to detect one osteoporotic patient among women older than 60 years and with BMI < 24.5 kg/m2 was 1.32. (Abstract truncated at 2000 characters).
Izvleček		Izhodišča. Predpogoj za zmanjšanje pojavnosti osteoporoznih zlomov je zgodnja prepoznava pomenopavznih žensk z osteoporozo z merjenjem mineralne kostne gostote (MKG). Glavno vlogo pri napotitvi takih bolnic na meritev imajo izbrani ginekologi in osebni zdravniki, vendar pa učinkovita merila presejanja glede na ceno merjenja MKG še niso določena. Merila, ki so trenutno na voljo (npr. SCORE, ORAI, ABONE), so zelo široka in njihova specifičnost je majhna. Namen naše raziskave je bil ovrednotiti preprosta pravila odločanja, ki bi lahko izboljšala prepoznavanje bolnic z velikim tveganjem za zlom in hkrati omogočila čim manj nepotrebnih meritev. Metode. V raziskavi je 357 osebnih zdravnikov in izbranih ginekologov preiskovanke napotilo na merjenje MKG po naslednjih pravilih odločanja: a) preiskovanka je že vsaj 5 let po menopavzi, b) preiskovankin indeks telesne mase (ITM) je manjši od 26 kg/m2 in c) preiskovanki niso še nikoli prej diagnosticirali osteoporoze. MKG ledvene hrbtenice in/ali kolka so preiskovankam izmerili z dvoenergijsko rentgensko absorpciometrijo (DXA) v 5 centrih z merilci Hologic (Hologic Corp., Bedford, MA, ZDA) ali Lunar (LunarCorp., Madison, WI, ZDA). Rezultate meritve z DXA, izražene kot vrednost T, so poslali zdravnikom v osnovnem zdravstvu. Rezultati. V raziskavi je sodelovalo 2339 preiskovank. Do konca raziskave je 327 zdravnikov (92%) sporočilo rezultate o meritvah pri 2196 preiskovankah (94%). Pri 1332 preiskovankah od 2196 (61%) je bila ugotovljena osteoporoza, pri 637 (29%) osteopenija, 227 (10%) pa jih je imelo normalno MKG. Približno 30% bolnic z osteoporozo je že imelo zlom po minimalni poškodbi. Med vsemi preiskovankami je bila prevalenca osteoporoze 34% pri mlajših od 55 let, 50% pri starosti 55-59 let in 69% pri starejših od 60 let. Za odkritje ene bolnice z osteoporozo med preiskovankami, starejšimi od 60 let in z ITM < 24,5 kg/m2 je bilo potrebno opraviti 1,32 DXA meritve. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		OSTEOPOROSIS RISK ASSESSMENT POSTMENOPAUSE BONE DENSITY BODY MASS INDEX PREVALENCE AGE FACTORS