Walters Samuel, Khan Tanvir, Ong Terence, Sahota Opinder
East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust.
Department of Orthopaedics, Trauma and Sports Medicine, University of Nottingham.
Clin Interv Aging. 2017 Jan 10;12:117-127. doi: 10.2147/CIA.S85551. eCollection 2017.
Fragility fractures are sentinels of osteoporosis, and as such all patients with low-trauma fractures should be considered for further investigation for osteoporosis and, if confirmed, started on osteoporosis medication. Fracture liaison services (FLSs) with varying models of care are in place to take responsibility for this investigative and treatment process. This review aims to describe outcomes for patients with osteoporotic fragility fractures as part of FLSs. The most intensive service that includes identification, assessment and treatment of patients appears to deliver the best outcomes. This FLS model is associated with reduction in re-fracture risk (hazard ratio [HR] 0.18-0.67 over 2-4 years), reduced mortality (HR 0.65 over 2 years), increased assessment of bone mineral density (relative risk [RR] 2-3), increased treatment initiation (RR 1.5-4.25) and adherence to treatment (65%-88% at 1 year) and is cost-effective. In response to this evidence, key organizations and stakeholders have published guidance and framework to ensure that best practice in FLSs is delivered.
脆性骨折是骨质疏松症的警示信号，因此，所有低创伤骨折患者都应考虑进一步检查是否患有骨质疏松症，如确诊，则应开始使用骨质疏松症药物治疗。各地设立了模式各异的骨折联络服务（FLS），负责这一检查和治疗过程。本综述旨在描述作为FLS一部分的骨质疏松性脆性骨折患者的治疗结果。包含患者识别、评估和治疗的最全面服务似乎能带来最佳治疗效果。这种FLS模式与再骨折风险降低（2至4年的风险比[HR]为0.18 - 0.67）、死亡率降低（2年的HR为0.65）、骨密度评估增加（相对风险[RR]为2 - 3）、治疗开始率增加（RR为1.5 - 4.25）以及治疗依从性提高（1年时为65% - 88%）相关，且具有成本效益。基于这一证据，主要组织和利益相关者已发布指南和框架，以确保FLS能提供最佳实践。
