Degli Esposti L, Sinigaglia L, Rossini M, Adami S, Cagnoni C, Magliaro C, Veronesi C, Buda S, Minisola S
CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy.
Reumatismo. 2012 Mar 16;64(1):18-26. doi: 10.4081/reumatismo.2012.18.
The aim of the present study was to evaluate the application into clinical practice of therapeutic and diagnostic recommendations for the prevention of bone re-fracture in postmenopausal women after an hospitalization for hip fracture in clinical practice and to assess the relationship between the application of diagnostic recommendations and re-fracture or death risk. A retrospective cohort analysis was conducted. All female patients, at least 65 years old, and with an hospitalization with main or secondary diagnosis of hip fracture during the period 1 January 2006 - 31 December 2008, were included. Besides demographic characteristics and comorbidities, drug treatment prescriptions related to bone fracture or supplementary with calcium or vitamin D and prescriptions of recommended laboratory and instrumental diagnostic tests (e.g. spine radiography), were analysed. A total of 5,636 patients were included in the study. The prescription of a drug treatment aimed to reduce the risk of re-fracture was found in 16.3% of patients, among them 76.3% (699 patients) used bisphosphonates only, 17.1% (157 patients) strontium ranelate only and 4.9% (45 patients) used more than one treatment during the observation period. Among the patients who did not receive drug treatment, 17.5% made use of only supplemental calcium and vitamin D. The remaining part of patients (69.1%) received no treatment. The prescription of at least one laboratory test of first and second level was performed, respectively, on 53.7% and 43.1% of included patients, whereas the prescription of at least one instrumental test of first and second level was performed, respectively, on 5.9% and 0.8%. Although it is established that the prescription of the recommended tests and appropriate drug treatment are significantly associated with reduced risk of re-fracture and death, today the application of these recommendations is reduced.
本研究的目的是评估治疗和诊断建议在临床实践中应用于预防绝经后妇女髋部骨折住院后再次骨折的情况，并评估诊断建议的应用与再次骨折或死亡风险之间的关系。进行了一项回顾性队列分析。纳入了所有年龄至少65岁、在2006年1月1日至2008年12月31日期间因髋部骨折为主诊断或次诊断而住院的女性患者。除了人口统计学特征和合并症外，还分析了与骨折相关的药物治疗处方或补充钙或维生素D的处方以及推荐的实验室和仪器诊断检查（如脊柱X线摄影）的处方。共有5636名患者纳入研究。在16.3%的患者中发现了旨在降低再次骨折风险的药物治疗处方，其中76.3%（699名患者）仅使用双膦酸盐，17.1%（157名患者）仅使用雷奈酸锶，4.9%（45名患者）在观察期内使用了不止一种治疗方法。在未接受药物治疗的患者中，17.5%仅使用了钙和维生素D补充剂。其余患者（69.1%）未接受治疗。分别对53.7%和43.1%的纳入患者进行了至少一项一级和二级实验室检查的处方，而分别对5.9%和0.8%的患者进行了至少一项一级和二级仪器检查的处方。尽管已确定推荐检查的处方和适当的药物治疗与降低再次骨折和死亡风险显著相关，但如今这些建议的应用率较低。
