风湿科医生对糖皮质激素性骨质疏松症认识的调查

A survey to glucocorticoid induced osteoporosis management in rheumatologists in China

目的了解国内风湿科医生对糖皮质激素性骨质疏松（GIOP）的认识及诊治习惯。方法对136例风湿科医生进行了关于GIOP的认识的现场问卷调查，同时收集答卷人的个人资料。结果共收回101份有效答卷，其中参加过继续教育的有59例；未参加过继续教育的有42例。占67．3％（68／101）的医生采用双光能X线吸收法作为诊断骨质疏松症的方法，但仅有28．7％（29／101）的医生正确选择了诊断骨质疏松的骨密度值，在实际工作中有84．2％（85／101）医生常根据骨关节X线进行诊断。对于绝经期后长期使用小剂量激素的患者，有87．1％（88／101）的医生会要求患者使用前检查骨密度，并有89．1％（90／101）的医生会同时给患者补充钙剂和维生素D，但仅有27．8％（25／90）的医生会同时选用双膦酸盐或雌激素替代治疗。对于年轻女性长期使用大剂量激素，仅有42．6％（43／101）医生建议患者使用前检查骨密度；在出现骨质疏松后，仅有47．5％（48／101）的医生会首选双膦酸盐治疗。仅有35．6％（36／101）的医生正确认识单用钙剂不能预防激素所致的骨量丢失，仅5．9％（56／101）的医生正确认识降钙素不能降低GIOP造成的骨折风险。接受过骨质疏松继续教育的医生诊断和处理骨质疏松的正确率明显高于未参加过相关继续教育的医生。结论国内风湿科医生对糖皮质激素性骨质疏松的认识与目前国际较为公认的意见有一定差异，接受相应的继续教育是提高医生认识水平的重要途径。

Objective To investigate the management protocols about glueoeorticoid induced osteoporosis by rheumatology physicians of China. Methods A questionnaire survey was conducted among 136 rheumatology physicians. Results 101 effective questionnaires were collected. 58.4 % responders have had continuous medical education（CME） about GIOP ;67.3 % respondents considered dual X-ray absorptiometry the preferred technique to assess bone mineral density, but 84.2% preferred radiation in daily practice. In dealing with postmenopausai patients starting long-term steroid therapy, 87.1% rheumatnlogists considered base bone mass should be measured, and calcium ＋ vitamin D was recommended by 89.1% rheumatologists, bisohosphonates or HRT were recommended by 27.8% rheumatologists only. In dealing with young women patients starting long-term steroid therapy, only 42.6% rheumatologists considered base bone mass shouid be measured, 47.5% preferred bisohosphonates to treat GIOP. Only 35.6 % rheumatologist considered calcium alone can not preserve bone mass; and only 5.9 % considered calcitonin can not prevent the fracture induced by GIOP. The responders who have had CME about GIOP were prone to take appropriate management. Conclusion The survey demonstrates the lack of consensus in management of GIOP by the rheumatologist in China with the internationally accepted guideline. High quality CME may improve the decision-making ability of rheumatologist.