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首页> 外文期刊>Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research >How Can We Improve Osteoporosis Care? A Systematic Review and Meta‐Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis
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How Can We Improve Osteoporosis Care? A Systematic Review and Meta‐Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis

机译：我们如何改善骨质疏松症护理？ 对骨质疏松症质量改善策略效果的系统评价和荟萃分析

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ABSTRACT Although osteoporosis affects 10 million people in the United States, screening and treatment rates remain low. We performed a systematic review and meta‐analysis of the efficacy of quality improvement strategies to improve osteoporosis screening (bone mineral density [BMD]/dual‐energy X‐ray absorptiometry [DXA] testing) and/or treatment (pharmacotherapy) initiation rates. We developed broad literature search strategies for PubMed, Embase, and Cochrane Library databases, and applied inclusion/exclusion criteria to select relevant studies. Random‐effects meta‐analyses were performed for outcomes of BMD/DXA testing and/or osteoporosis treatment. Forty‐three randomized clinical studies met inclusion criteria. For increasing BMD/DXA testing in patients with recent or prior fracture, meta‐analyses demonstrated several efficacious strategies, including orthopedic surgeon or fracture clinic initiation of osteoporosis evaluation or management (risk difference 44%, 95% confidence interval [CI] 26%–63%), fracture liaison service/case management (risk difference 43%, 95% CI 23%–64%), multifaceted interventions targeting providers and patients (risk difference 24%, 95% CI 15%–32%), and patient education and/or activation (risk difference 16%, 95% CI 6%–26%). For increasing osteoporosis treatment in patients with recent or prior fracture, meta‐analyses demonstrated significant efficacy for interventions of fracture liaison service/case management (risk difference 20%, 95% CI 1%–40%) and multifaceted interventions targeting providers and patients (risk difference 12%, 95% CI 6%–17%). The only quality improvement strategy for which meta‐analysis findings demonstrated significant improvement of osteoporosis care for patient populations including individuals without prior fracture was patient self‐scheduling of DXA plus education, for increasing the outcome of BMD testing (risk difference 13%, 95% CI 7%–18%). The meta‐analyses findings were limited by small number of studies in each analysis; high between‐study heterogeneity; sensitivity to removal of individual studies; and unclear risk of bias of included studies. Despite the limitations of the current body of evidence, our findings indicate there are several strategies that appear worthwhile to enact to try to improve osteoporosis screening and/or treatment rates. ? 2018 American Society for Bone and Mineral Research.
机译：摘要虽然骨质疏松症在美国影响了1000万人，但筛查和治疗率仍然很低。我们对改善骨质疏松症筛查（骨矿物密度[BMD] /双能X射线吸收测定率和/或治疗）和/或治疗（药物治疗）启动率进行系统审查和荟萃分析我们开发了广泛的文献搜索策略，适用于PubMed，Embase和Cochrane库数据库，并应用包含/排除标准来选择相关研究。对BMD / DXA测试和/或骨质疏松症治疗的结果进行随机效应元分析。四十三个随机临床研究符合纳入标准。用于增加近期或先前骨折患者的BMD / DXA测试，Meta-Analys展示了几种有效的策略，包括骨科外科医生或骨折临床启动骨质疏松症评估或管理（风险差44％，95％置信区间[CI] 26％ - 63％），骨折联络服务/案例管理（风险差异43％，95％CI 23％-64％），多方面的干预措施靶向提供者和患者（风险差异24％，95％CI 15％-32％）和患者教育和/或激活（风险差异16％，95％CI 6％-26％）。对于近期或先前骨折患者的骨质疏松症治疗，META分析表明了骨折联络服务/案例管理干预的显着效果（风险差20％，95％CI 1％-40％）和靶向提供者和患者的多方面的干预措施（风险差异12％，95％CI 6％-17％）。荟萃分析结果的唯一质量改进策略表现出对患者群体的骨质疏松症护理的显着改善，包括患者的患者，患者是DXA Plus教育的自我调度，用于增加BMD测试的结果（风险差异13％，95％ CI 7％-18％）。 Meta-Analyses在每次分析中的研究数量有限;高等学之间的异质性;敏感性地去除个人研究;和不明确的研究偏见的风险。尽管目前证据的局限性，我们的调查结果表明有几种策略表明，尝试改善骨质疏松症和/或治疗率的治疗有价值。还2018年美国骨骼和矿物学研究。

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