骨科代谢协同管理治疗骨质疏松性髋部骨折。

Orthopedic-Metabolic Collaborative Management for Osteoporotic Hip Fracture.

出版信息

Endocr Pract. 2018 Aug;24(8):718-725. doi: 10.4158/EP-2018-0082. Epub 2018 Aug 7.

DOI:10.4158/EP-2018-0082

Abstract

OBJECTIVE

Osteoporotic hip fractures are associated with increased morbidity, mortality, and secondary fractures. Although osteoporosis treatment can reduce future fracture risk, patients often do not receive it. We report results of a coordinator-less fracture liaison service in Israel addressing hip fracture patients. The primary endpoint was attending the Metabolic Clinic. Secondary endpoints included vitamin D measurement, calcium and vitamin D recommendations, initiation of osteoporosis treatment, and mortality 1-year post-fracture.

METHODS

This prospective study included 219 hip fracture patients who were compared with historical controls. Data on hospitalized patients were collected before and after implementation of a structured protocol for hip fracture patients, led by a multidisciplinary team, without a coordinator.

RESULTS

The study included 219 and 218 patients ≥60 years old who were operated on in 2013 and 2012, respectively. Metabolic Clinic visits increased from 6.4 to 40.2% after the intervention ( P<.001). Among 14 patients who attended the Clinic in 2012, 85.7% began osteoporosis therapy; among 88 who attended in 2013, 45.5% were treated at the first visit. Vitamin D measurements and calcium and vitamin D supplementation increased postintervention (0.5-80.1%, P<.001; 30.8-84.7%, P<.001, respectively). Patients receiving osteoporosis medications had lower mortality rates than untreated patients (4.3% vs. 21.8%).

CONCLUSION

An Orthopedic-Metabolic team implemented by existing staff without a coordinator can improve osteoporosis care for hip fracture patients. Yet, gaps remain as only 40% had Metabolic Clinic follow-up postintervention, and of these, only half received specific treatment recommendations. Hospitals are encouraged to adopt secondary fracture prevention protocols and continuously improve them to close the gaps between current management and appropriate metabolic assessment and treatment.

ABBREVIATIONS

CHS = Clalit Health Services; CI = confidence interval; FLS = fracture liaison service; HMO = health maintenance organization; OR = odds ratio.

摘要

目的

骨质疏松性髋部骨折会增加发病率、死亡率和继发性骨折。尽管骨质疏松症治疗可以降低未来骨折的风险，但患者往往无法接受治疗。我们报告了以色列无协调员骨折联络服务在髋部骨折患者中的结果。主要终点是参加代谢诊所。次要终点包括维生素 D 测量、钙和维生素 D 建议、开始骨质疏松症治疗以及骨折后 1 年的死亡率。

方法

这项前瞻性研究纳入了 219 例髋部骨折患者，并与历史对照进行了比较。在实施多学科团队领导的髋部骨折患者结构化方案之前和之后，收集了住院患者的数据，该方案无需协调员。

结果

研究包括分别于 2013 年和 2012 年接受手术的 219 名和 218 名≥60 岁的患者。代谢诊所就诊率从干预前的 6.4%增加到 40.2%（P<.001）。在 2012 年就诊于诊所的 14 名患者中，85.7%开始接受骨质疏松症治疗；在 2013 年就诊的 88 名患者中，45.5%在首次就诊时接受了治疗。维生素 D 测量值以及钙和维生素 D 补充剂的用量在干预后增加（0.5-80.1%，P<.001；30.8-84.7%，P<.001）。接受骨质疏松症药物治疗的患者死亡率低于未治疗患者（4.3%比 21.8%）。