Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, Chu-Tung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan.
Sci Rep. 2019 Jul 12;9(1):10089. doi: 10.1038/s41598-019-46315-4.
Osteoporosis medication in fragility fracture patients is associated with better outcomes. However, limited studies have investigated whether fracture types affect outcomes among patients undergoing treatment. We performed a secondary data analysis on participants from a fracture liaison service and an osteoporosis medication management service. Participants (n = 974) were regrouped into hip fracture (HF), vertebral fracture (VF), HF + VF, and NO HF/VF groups at baseline. Bivariate and multivariate logistic regressions were performed to identify baseline correlates on one-year mortality, incident refractures, and falls. Baseline characteristics were different among fracture groups. The HF group was oldest, with the lowest body mass index (BMI), lowest FRAX® T-score and had the highest 10-year fracture risk. After intervention, the HF group still had the highest mortality, but the HF + VF group had the highest refracture and incident fall rates. In the multivariate regression analysis, prevalent HF and VF, lower BMI and albumin level, and having chronic kidney disease or cancer were associated with higher mortality rates. HF + VF patients had the highest refracture risk. Prevalent HF and VF, older age and higher BMI, and having cancer or osteoarthritis were associated with a greater fall risk. HF and VF are associated with adverse outcomes, even under an optimal fracture care.
脆性骨折患者使用骨质疏松药物与更好的结局相关。然而,有限的研究调查了骨折类型是否会影响接受治疗的患者的结局。我们对骨折联络服务和骨质疏松药物管理服务的参与者进行了二次数据分析。参与者(n=974)在基线时重新分为髋部骨折(HF)、椎体骨折(VF)、HF+VF 和无 HF/VF 组。进行了单变量和多变量逻辑回归分析,以确定一年死亡率、新发骨折和跌倒的基线相关因素。骨折组的基线特征不同。HF 组年龄最大,体重指数(BMI)最低,FRAX® T 评分最低,10 年骨折风险最高。干预后,HF 组的死亡率仍然最高,但 HF+VF 组的新发骨折和跌倒发生率最高。在多变量回归分析中,现患 HF 和 VF、较低的 BMI 和白蛋白水平以及患有慢性肾脏病或癌症与更高的死亡率相关。HF+VF 患者的骨折复发风险最高。现患 HF 和 VF、年龄较大和较高的 BMI 以及患有癌症或骨关节炎与更高的跌倒风险相关。即使在最佳骨折治疗下,HF 和 VF 也与不良结局相关。