本帖最後由 lsc0019 於 2009-5-24 21:50 編輯
作者：Kathleen Louden
出處：WebMD醫學新聞
May 5, 2009（伊利諾州芝加哥）－根據一項發表於美國老年醫學會年會的研究發現，停經黑人女性，有骨質疏鬆症危險因子，接受骨質密度劑篩檢的比例低於16%，且初級照護醫師比專科照護醫師醫囑進行骨密度篩檢的比例要來得低。
主要作者、俄亥俄州Beachwood克里夫蘭診所醫院Huron分院第二年住院醫師Youngdoo Chang醫師表示，在社區健康中心的醫師對那些將骨質疏鬆症視為非健康關注重點的黑人女性進行訪查，研究中的402位女性，有15.9%接受雙能X射線吸收計（XDA）篩檢。
這項研究中的女性都是65歲以上，且根據她們在社區健康中心的病歷，判斷有骨質疏鬆症的危險因子。
Chang醫師在與Medscape內科學的訪談中表示，即使過去的研究已經證實，相較於白人，非裔女性在骨折後死亡率較高，但醫師並未對有骨質疏鬆症危險因子的黑人女性醫囑DXA掃描。
作者在他們的壁報中表示，除此之外，未接受DXA篩檢的女性，診斷罹患骨質疏鬆症的比例是很高的(29.6%)；Chang醫師表示，這個數字比其他研究中所報告的高。
【醫囑DXA的障礙】
如果病患沒有私人保險的話，這項研究中的醫師比較少醫囑DXA篩檢。雖然作者們並未詢問醫師有關於沒有進行DXA篩檢的原因，Chang醫師指出，這顯然是因為這項篩檢未給付的錯誤認知。
根據這項摘要，另一個進行DXA篩檢的障礙是年紀大；接受骨密度篩檢病患的平均年齡為71歲，然而，未接受骨密度篩檢病患的平均年齡則是75歲。
醫師被要求根據他們的優先順序排列以下這些醫療疾病，包括大腸癌、乳癌、高血脂、子宮頸癌篩檢、家暴、物質濫用以及骨質疏鬆症；在這項研究中，醫師最優先的選擇為醫囑大腸鏡與乳房攝影。
Chang醫師表示，停經後骨質疏鬆症女性的比例，在黑人為4%，白人為8%，這可能影響了醫師的優先考慮。
Chang醫師指出，如果主治醫師將DXA視為高優先性，病患就比較可能接受這樣的篩檢；我們必須增加醫師關於有骨質疏鬆症危險因子黑人女性接受DXA需求的教育。
摘要中記載，可能的、缺乏與骨質疏鬆症危險因子的認知，可能造成這項研究中DXA篩檢率低的原因之一。
研究結果顯示，老人醫學與風濕免疫專家比其他初級照護醫師更可能醫囑進行DXA篩檢。
【研究限制】
這項研究的一個限制是，研究假設沒有接受DXA的女性，是因為醫師沒有轉介她進行這樣的篩檢，但並不十分確定。
來自南阿肯色州EI Dorado老年中心的老年醫學醫師Ruxandra Jadic表示，其次，在402位受試者中，這項研究缺乏足夠的統計力量；Jadic醫師並未參與研究，但觀看這篇壁報。
雖然如此，Jadic醫師同意需要更好的醫師教育；她表示，初級照護醫師與其他醫師必須對骨質疏鬆症為黑人女性的一個問題提高警覺，且這些病患更容易死於骨折；醫師應該檢視他們的轉介習慣，看是不是有什麼誤差。
Jadic醫師表示，在她的臨床經驗中，針對居住於農村的族群，黑人病患傾向於抗拒任何形式的預防性篩檢，因此她相信要改變這個問題，同時也有公共衛生教育。
Chang醫師與Jadic醫師表示沒有相關資金上的往來。
AGS 2009: Elderly Black Women Have Low Rate of Bone-Density Screening
By Kathleen Louden
Medscape Medical News
May 5, 2009 (Chicago, Illinois) — The densitometry screening rate is less than 16% in postmenopausal black women with risk factors for osteoporosis, and primary-care physicians are even less likely than specialists to order bone-density scans, according to a study presented here at the American Geriatrics Society Annual Scientific Meeting.
Physicians at a community health center who were surveyed rated osteoporosis a low health concern for their black female patients, and just 15.9% of 402 women in the study underwent screening with dual-energy X-ray absorptiometry (DXA), said lead author Youngdoo Chang, MD, a second-year resident at Huron Hospital, a Cleveland Clinic hospital in Beachwood, Ohio.
All women in the study were 65 years or older and had risk factors for osteoporosis identified in their medical records at the community health center.
"Doctors are not ordering DXA scans in black women who have risk factors for osteoporosis, even though [previous research has shown that] African American women have a higher mortality after osteoporotic fracture, compared with whites," Dr. Chang told Medscape Internal Medicine in an interview.
Furthermore, the prevalence of diagnosed osteoporosis was high — 29.6% — in the women who did undergo DXA, the authors report in their poster abstract. The prevalence was higher than that reported in other studies, Dr. Chang said.
Barriers to Ordering DXA
Physicians in the study were less likely to order DXA screening if the patient did not have private insurance. Although the authors did not ask physicians their reasons for not ordering DXA, Dr. Chang said it appears that there is a misperception that this test is not reimbursable.
Another barrier to DXA screening was old age, according to the abstract. The average age of women who received bone-density screening was 71 years, whereas the average age of the women who did not undergo the procedure was 75 years.
Physicians were asked to rank the following medical categories according to their priorities: colon cancer, breast cancer, hyperlipidemia, Papanicolaou test, domestic violence, substance abuse, and osteoporosis. Ordering colonoscopies and mammograms were the highest priorities of physicians in this study.
The prevalence of osteoporosis in postmenopausal women is 4% in blacks and 8% in whites, which might have influenced physician priorities, Dr. Chang said.
"If the attending physician views DXA as a high priority, the patient is more likely to get one," he said. "We need to increase physician education about the need for DXA in black women who have risk factors for osteoporosis."
Possibly, a lack of recognition of osteoporosis risk factors contributed to the low rate of DXA screening in this study, the abstract states.
Specialists such as geriatricians and rheumatologists were more likely to order DXA screening scans than were primary-care physicians, the results showed.
Study Limitations
A limitation of the study was that it assumed, but did not know for sure, that the women who did not undergo DXA did not have a physician referral for it.
Also, at 402 participants, the study lacked sufficient power, Ruxandra Jadic, MD, a geriatrician from the South Arkansas Center on Aging in El Dorado, told Medscape Internal Medicine. She viewed the poster but was not affiliated with the study.
Still, Dr. Jadic agreed that better physician education is needed. "Primary-care physicians and other doctors need to be more aware that osteoporosis is a problem in black women and that they are more likely to die after fracture," she said. "Doctors should look at their referral habits to make sure there is no bias."
In her clinical experience in a rural population, black patients tend to be more resistant to any kind of preventive screening, Dr. Jadic said, so she believes public education is needed as well.
Dr. Chang and Dr. Jadic have disclosed no relevant financial relationships.
American Geriatrics Society (AGS) 2009 Annual Scientific Meeting: Abstract A80. Presented April 30, 2009. |
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