Department of Internal Medicine, VieCuri, Medical Center Noord-Limburg, PO Box 1926, 5900 BX, Venlo, The Netherlands.
Nat Rev Rheumatol. 2012 Jan 17;8(3):163-72. doi: 10.1038/nrrheum.2011.217.
In almost all patients with incident fractures, the absolute risk of subsequent fracture and mortality is highest immediately after the fracture is incurred; the risk is substantially increased in frail elderly patients. The risk factors for incident fractures, such as bone fragility, tendency to fall and the presence of metabolic bone disease, remain underdiagnosed and undertreated. Here, we review the evidence that demonstrates the influence of these risk factors on susceptibility to subsequent fracture and mortality after an incident fracture, and discuss the tools available to predict these outcomes. In this Review, we also propose a systematic, coordinator-based approach to assessment of risk, allocation of treatment and follow-up in all patients over 50 years of age who present with a fracture. The aim of this proposed multistep procedure is to improve the prevention of secondary fracture, decrease mortality rates and reduce patient undertreatment or overtreatment.
在几乎所有发生骨折的患者中，骨折发生后立即发生后续骨折和死亡的绝对风险最高；身体虚弱的老年患者风险大大增加。骨折的风险因素，如骨脆弱、易跌倒和存在代谢性骨病，仍然诊断不足和治疗不足。在这里，我们回顾了这些风险因素对骨折后发生后续骨折和死亡的易感性的影响的证据，并讨论了预测这些结果的可用工具。在这篇综述中，我们还提出了一种系统的、以协调员为基础的方法，用于评估所有 50 岁以上出现骨折的患者的风险、治疗分配和随访。该多步骤程序的目的是改善继发性骨折的预防，降低死亡率，并减少患者治疗不足或过度治疗的情况。
