Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago School of Medicine and Biological Sciences, Chicago, Illinois.
College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa.
J Bone Joint Surg Am. 2018 Apr 18;100(8):680-685. doi: 10.2106/JBJS.17.00665.
We are not aware of any previous investigation assessing a national cohort of patients enrolled in a fracture liaison service (FLS) program in an open health-care system to ascertain prevalent practice patterns. The objective of this investigation was to determine, in a geographically diverse group of centers in a single FLS program, the percentage of patients for whom anti-osteoporosis treatment was recommended or started as well as to identify associations between patient and fracture variables and the likelihood of treatment being recommended.
The study utilized the Own the Bone program registry, which included 32,671 unique patient records with the required data. The primary outcome measure was whether a recommendation to start anti-osteoporosis treatment was made to the patient at the time of program enrollment. The associations between patient and fracture variables and the likelihood of having treatment recommended were calculated.
Anti-osteoporosis treatment was recommended to 72.8% of patients and was initiated for 12.1%. A sedentary lifestyle and a parent who had sustained a hip fracture increased the likelihood of a treatment recommendation by 10% and 12%, respectively. While patients with a spinal fracture were 11% more likely to have received a treatment recommendation, those with a hip fracture were 2% less likely to have received such a recommendation. Age was not strongly associated with the likelihood of receiving a treatment recommendation but was associated with the initiation of treatment.
Practitioners at sites in the Own the Bone program recommend anti-osteoporosis treatment, at the time of initial evaluation, to about three-quarters of patients who present with a fragility fracture. This is a very strong improvement over previously reported national data. The findings that a hip fracture had the lowest association and age had very little association with the likelihood of recommending treatment were unexpected and perhaps deserve further investigation.
FLS programs and sites as well as all those who manage patients with a fragility fracture can utilize the information derived from this study to improve practice patterns for the care of these patients.
我们不清楚之前是否有研究评估在开放医疗体系中参与骨折联络服务（FLS）项目的全国患者队列，以确定普遍的实践模式。本研究的目的是在单一 FLS 项目中地理分布多样化的中心确定有多少患者被建议或开始接受抗骨质疏松治疗，并确定患者和骨折变量与治疗建议可能性之间的关联。
本研究利用了 Own the Bone 项目的注册登记系统，其中包含 32671 名具有所需数据的独特患者记录。主要结局指标是在项目入组时是否向患者提出开始抗骨质疏松治疗的建议。计算了患者和骨折变量与治疗建议可能性之间的关联。
72.8%的患者被建议接受抗骨质疏松治疗，其中 12.1%开始接受治疗。久坐的生活方式和父母曾发生髋部骨折分别使治疗建议的可能性增加了 10%和 12%。脊柱骨折患者接受治疗建议的可能性增加了 11%，而髋部骨折患者接受治疗建议的可能性降低了 2%。年龄与接受治疗建议的可能性没有很强的关联，但与开始治疗有关。
Own the Bone 项目中各站点的医生在对初次就诊的脆性骨折患者进行评估时，约有四分之三的患者建议接受抗骨质疏松治疗。这与之前报告的全国数据相比有很大的改善。髋部骨折与治疗建议可能性的关联最低，而年龄与治疗建议可能性的关联非常小，这些发现出人意料，可能需要进一步研究。
FLS 项目和站点以及所有管理脆性骨折患者的人员都可以利用本研究得出的信息来改善这些患者的护理实践模式。
