The CORE Institute, Phoenix, Arizona.
MORE Foundation, Phoenix, Arizona.
J Bone Joint Surg Am. 2018 Nov 7;100(21):1819-1828. doi: 10.2106/JBJS.17.01388.
Osteoporosis is prevalent in the United States, with an increasing need for management. In this study, we evaluated the effectiveness of a private orthopaedic practice-based osteoporosis management service (OP MS) in reducing subsequent fracture risk and improving other aspects of osteoporosis management of patients who had sustained fractures.
This was a retrospective cohort study using the 100% Medicare data set for Michigan residents with any vertebral; hip, pelvic or femoral; or other nonvertebral fracture during the period of April 1, 2010 to September 30, 2014. Patients who received OP MS care with a follow-up visit within 90 days of the first fracture, and those who did not seek OP MS care but had a physician visit within 90 days of the first fracture, were considered as exposed and unexposed, respectively (first follow-up visit = index date). Eligible patients with continuous enrollment in Medicare Parts A and B for the 90-day pre-index period were followed until the earliest of death, health-plan disenrollment, or study end (December 31, 2014) to evaluate rates of subsequent fracture, osteoporosis medication prescriptions filled, and bone mineral density (BMD) assessments. Health-care costs were evaluated among patients with 12 months of post-index continuous enrollment. Propensity-score matching was used to balance differences in baseline characteristics. Each exposed patient was matched to an unexposed patient within ± 0.01 units of the propensity score. After propensity-score matching, Cox regression examined the hazard ratio (HR) of clinical and economic outcomes in the exposed and unexposed cohorts.
Two well-matched cohorts of 1,304 patients each were produced. The exposed cohort had a longer median time to subsequent fracture (998 compared with 743 days; log-rank p = 0.001), a lower risk of subsequent fracture (HR = 0.8; 95% confidence interval [CI] = 0.7 to 0.9), and a higher likelihood of having osteoporosis medication prescriptions filled (HR = 1.7; 95% CI = 1.4 to 2.0) and BMD assessments (HR = 4.3; 95% CI = 3.7 to 5.0). The total 12-month costs ($25,306 compared with $22,896 [USD]; p = 0.082) did not differ significantly between the cohorts.
A private orthopaedic practice-based OP MS effectively reduced subsequent fracture risk, likely through coordinated and ongoing comprehensive patient care, without a significant overall higher cost.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
骨质疏松症在美国很普遍，其管理需求日益增加。在这项研究中，我们评估了私人骨科实践为基础的骨质疏松症管理服务（OP MS）在降低后续骨折风险和改善已发生骨折患者的骨质疏松症管理其他方面的有效性。
这是一项回顾性队列研究，使用密歇根州居民的 100%医疗保险数据集，纳入在 2010 年 4 月 1 日至 2014 年 9 月 30 日期间发生任何椎体；髋部、骨盆或股骨；或其他非椎体骨折的患者。在第一次骨折后 90 天内接受 OP MS 治疗并在第一次骨折后 90 天内进行随访的患者被视为暴露组，而未接受 OP MS 治疗但在第一次骨折后 90 天内接受医生就诊的患者被视为未暴露组（第一次随访就诊=索引日期）。符合条件的患者在索引前 90 天内持续参加医疗保险 A 部分和 B 部分，直到最早的死亡、退出健康计划或研究结束（2014 年 12 月 31 日），以评估随后骨折、骨质疏松症药物处方开具和骨密度（BMD）评估的发生率。对有 12 个月索引后连续参保的患者进行医疗费用评估。使用倾向评分匹配来平衡基线特征的差异。在 ± 0.01 单位的倾向评分范围内，将每个暴露患者与未暴露患者相匹配。在进行倾向评分匹配后，Cox 回归分析了暴露组和未暴露组临床和经济结局的风险比（HR）。
生成了两个匹配良好的队列，每个队列各有 1304 例患者。暴露组的后续骨折中位时间更长（998 天与 743 天；对数秩检验，p=0.001），后续骨折风险更低（HR=0.8；95%置信区间[CI]为 0.7 至 0.9），更有可能开具骨质疏松症药物处方（HR=1.7；95%CI 为 1.4 至 2.0）和进行 BMD 评估（HR=4.3；95%CI 为 3.7 至 5.0）。两个队列的 12 个月总费用（$25306 与 $22896[美元]；p=0.082）无显著差异。
私人骨科实践为基础的 OP MS 可有效降低后续骨折风险，这可能是通过协调和持续的全面患者护理实现的，且不会显著增加总体成本。
治疗性 III 级。有关证据水平的完整描述，请参阅作者说明。
