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Osteoporos Int. 2017 Oct;28(10):2843-2851. doi: 10.1007/s00198-017-4110-4. Epub 2017 Jun 24.
Although fractures are associated with short-term reductions in functional status, there is limited information on longer-term burden of fracture. This study documents evidence of an association between fractures and significant declines and functional health and activities that persist but attenuate beyond two years.
Although fractures are associated with short-term reductions in functional status and may have other short-term effects on healthcare utilization (hospitalization and follow-up care), there is limited information on long-term burden of fracture beyond 12 to 24 months post-fracture. Analysis of the long-term health burden can inform policymakers, health care practitioners, and payers.
We acquired a data set containing the 1992-2012 Health and Retirement Survey data linked to the same individuals' Medicare claims. Fracture cases (n = 745) were matched to non-fracture controls using propensity scores matching. A regression-adjusted difference-in-difference (DD) approach was used to compare the change in functional status measures from baseline to two post-fracture periods for fracture cases relative to the change over the same time periods for matched controls. Self-reported measures of functional status were examined: limitations to activities of daily living (ADLs), limitations to instrumental activities of daily living (IADLs), a mobility index, a gross motor skills index, a fine motor skills index, and self-reported general health status.
Fracture cases reported increases in limitations to ADLs, difficulties with mobility, difficulties with gross motor skills, and difficulties with fine motor skills in each HRS collection period (the survey is administered every 2 years) following the fracture or index date (thus up to two years later) than matched controls (all p values < 0.05). The magnitude of these effects diminished in the second post-fracture wave (two to four years after fracture/index date), but they were still statistically significant.
Results suggest that fractures are associated with significant declines in some measures of functional activities up to two years following the fracture. The effects persist beyond two years but are smaller in magnitude.
虽然骨折与短期功能状态下降有关，但关于骨折长期负担的信息有限。本研究记录了骨折与功能健康和活动的显著下降以及持续存在但在两年后减弱的关联的证据。
虽然骨折与短期功能状态下降有关，并且可能对医疗保健利用（住院和随访护理）产生其他短期影响，但关于骨折后 12 至 24 个月以上的长期骨折负担的信息有限。对长期健康负担的分析可以为政策制定者、医疗保健从业者和支付者提供信息。
我们获取了一个包含 1992 年至 2012 年健康与退休调查数据和相同个体的医疗保险索赔数据的数据集。使用倾向评分匹配将骨折病例（n=745）与非骨折对照进行匹配。使用回归调整后的差值（DD）方法比较骨折病例相对于匹配对照在骨折后两个时期和同一时期的功能状态测量指标的变化。检查了自我报告的功能状态测量结果：日常生活活动（ADL）受限、工具性日常生活活动（IADL）受限、活动能力指数、大运动技能指数、精细运动技能指数和自我报告的一般健康状况。
与匹配对照相比，骨折病例在骨折或指数日期后的每个 HRS 采集期（该调查每两年进行一次）报告 ADL 受限、移动困难、大运动技能困难和精细运动技能困难增加（所有 p 值均<0.05）。这些影响在第二次骨折波（骨折/指数日期后两到四年）中减弱，但仍具有统计学意义。
结果表明，骨折与骨折后两年内某些功能活动指标的显著下降有关。这些影响持续存在，但幅度较小。
