Parikh Seema, Avorn Jerry, Solomon Daniel H
Brigham and Womens' Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2009 Feb;57(2):327-34. doi: 10.1111/j.1532-5415.2008.02119.x.
Nursing home (NH) residents fall 11 times as frequently as their age-matched community-dwelling counterparts. The benefits of fall prevention strategies and hip protectors in terms of fracture risk in this setting are unclear. Moreover, there is no consensus on the efficacy of osteoporosis medication in NH residents. A systematic review was conducted to evaluate the efficacy of medications for osteoporosis in this population and to examine utilization studies in the NH setting to define prescribing practices. Electronic searches of MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were supplemented with a hand search of bibliographies. All English-language studies published between January 1, 1974, and December 31, 2006, that studied osteoporosis pharmacotherapy in the NH environment were obtained, and studies of medication benefits and utilization patterns were identified. No restrictions were placed on study method. Studies required inclusion of NH patients and extractable data with bone mineral density (BMD) or fracture outcomes. Forty full-text articles were retrieved, of which 15 studies met selection criteria. In the nine studies examining medication effects, calcium (1,200 mg) and vitamin D (800 IU) supplementation were shown to reduce fracture risk and improve BMD. One study supported the role of alendronate, but none documented the utility of raloxifene, calcitonin, or teriparatide in NH residents. All six medication utilization studies reported infrequent use of osteoporosis medications (9-25%). Prescribing for elderly NH patients is difficult, considering the risk:benefit ratio and issues of longevity, but these medications may be underused in the NH environment.
养老院（NH）居民跌倒的频率是与其年龄相仿的社区居家居民的11倍。在此环境下，预防跌倒策略和髋部保护器在降低骨折风险方面的益处尚不清楚。此外，对于养老院居民使用骨质疏松症药物的疗效也没有达成共识。本研究进行了一项系统综述，以评估该人群使用骨质疏松症药物的疗效，并审查养老院环境中的用药情况研究以确定处方习惯。通过对MEDLINE、EMBASE、CINAHL和Cochrane对照试验中央注册库进行电子检索，并辅以手工检索参考文献。获取了1974年1月1日至2006年12月31日期间发表的所有研究养老院环境中骨质疏松症药物治疗的英文研究，并确定了药物益处和使用模式的研究。对研究方法没有限制。研究要求纳入养老院患者以及可提取的骨密度（BMD）或骨折结局数据。共检索到40篇全文文章，其中15项研究符合入选标准。在9项研究药物疗效的研究中，补充钙（1200毫克）和维生素D（800国际单位）可降低骨折风险并改善骨密度。一项研究支持阿仑膦酸盐的作用，但没有研究记录雷洛昔芬、降钙素或特立帕肽在养老院居民中的效用。所有6项药物使用情况研究均报告骨质疏松症药物的使用频率较低（9%-25%）。考虑到风险效益比和寿命问题，为老年养老院患者开处方很困难，但这些药物在养老院环境中可能未得到充分使用。
