在急性康复环境中，老年人对骨质疏松性骨折二级预防的治疗接受度低。
Low acceptance of treatment in the elderly for the secondary prevention of osteoporotic fracture in the acute rehabilitation setting.
机构信息
Institute for Aging Research, Hebrew SeniorLife, MA 02131, USA.
出版信息
Aging Clin Exp Res. 2010 Jun;22(3):231-7. doi: 10.1007/BF03324801.
BACKGROUND AND AIMS
Given the high risk of subsequent fracture among elderly persons with fracture, it is important to initiate secondary treatment for osteoporosis. Acute rehabilitation centers may offer a unique opportunity to introduce treatment. Therefore, we evaluated willingness-to-participate and compliance with evidence-based interventions for the secondary prevention of osteoporotic fracture in a non-randomized study conducted in the acute rehabilitation setting. We also described differences in baseline characteristics between study participants and non-participants.
METHODS
All consecutive, community dwelling admissions to an acute rehabilitation unit (Boston, MA) with the diagnosis of fracture were screened for enrollment. Eligible subjects were offered a free, 6-month supply of alendronate/cholecalciferol (70 mg/2800 IU weekly), calcium and vitamin D supplements, and fall prevention strategies. Six-month compliance (> or =75% consumption of medication or supplement) with the interventions was determined at a home visit.
RESULTS
Among 62 eligible subjects, 25 agreed to participate. Non-participants were older than participants (86 vs 80 yrs, p<0.01). There was no significant difference between other characteristics of participants and non-participants including sex, weight, type of fracture, cognitive status, and functional status. The most common reason for non-participation was reluctance to take another medication. Among participants, only 52% were compliant with alendronate and 58% were compliant with calcium and vitamin D supplementation at 6 months.
CONCLUSIONS
Willingness- to-participate and compliance with secondary prevention strategies for osteoporosis was low in the acute rehabilitation setting, even when medications were provided free of cost. Educating individuals with fracture and their families on the consequences and treatment of osteoporosis may help to decrease the risk of sustaining a second fracture by accepting secondary preventive measures.
背景与目的
鉴于老年人骨折后再次骨折的风险较高，因此必须对骨质疏松症进行二级治疗。急性康复中心可能提供引入治疗的独特机会。因此，我们在急性康复环境中进行了一项非随机研究，评估了对骨质疏松性骨折二级预防的基于证据的干预措施的参与意愿和依从性，并描述了研究参与者和非参与者之间的基线特征差异。
方法
对波士顿急性康复病房中所有符合条件的社区居住的骨折患者进行筛查，以确定是否纳入研究。符合条件的患者可获得为期 6 个月的阿伦膦酸钠/胆钙化醇（每周 70mg/2800IU）、钙和维生素 D 补充剂以及预防跌倒的策略。通过家访确定 6 个月时对干预措施的依从性（>或=75%的药物或补充剂的使用率）。
结果
在 62 名符合条件的患者中，有 25 名同意参与。非参与者比参与者年龄更大（86 岁比 80 岁，p<0.01）。参与者和非参与者在其他特征上没有显著差异，包括性别、体重、骨折类型、认知状态和功能状态。不参与的最常见原因是不愿意再服用另一种药物。在参与者中，只有 52%的人在 6 个月时坚持服用阿伦膦酸钠，58%的人坚持服用钙和维生素 D 补充剂。
结论
即使免费提供药物，急性康复环境中骨质疏松症二级预防策略的参与意愿和依从性仍然较低。对骨折患者及其家属进行骨质疏松症后果和治疗的教育可能有助于通过接受二级预防措施来降低再次骨折的风险。
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