Rhode Island Hospital, Providence, Rhode Island.
Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island.
J Am Geriatr Soc. 2020 Feb;68(2):256-260. doi: 10.1111/jgs.16176. Epub 2019 Oct 3.
Bisphosphonates are effective at preventing hip fractures among older adults, yet many patients still fracture while on treatment and may benefit from additional preventive interventions. Little data are specifically available to target such efforts among bisphosphonate users. We aimed to identify predictors of hip fracture unique to frail older adults initiating pharmacologic treatment for osteoporosis.
Retrospective cohort using 2008-2013 linked national Minimum Data Set assessments, Medicare claims, and nursing home (NH) facility data.
NHs in the United States.
Long-stay NH residents 65 years or older who initiated treatment with a bisphosphonate (N = 17 753). Estimates for bisphosphonate initiators were contrasted with those for calcitonin initiators (control group; N = 5348).
Hospitalized hip fracture outcomes were measured using Part A claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for 36 a priori selected potential predictors.
The mean (SD) age of the study population was 84 (8) years, 85% were women, and 51% had moderate to severe cognitive impairment. Predictors associated with a higher risk of hip fracture despite bisphosphonate use included age 75 years or older to 85 years (vs ≥65 to <75 y; HR = 1.25; 95% CI = 1.02-1.55), female sex (HR = 1.33; 95% CI = 1.06-1.67), white race (vs black race (HR = 1.87; 95% CI = 1.36-2.58), and body mass index = 18.5-24.9 (vs ≥30; HR = 1.93; 95% CI = 1.53-2.42). Independent ability to transfer (vs total dependence; HR = 3.11; 95% CI = 1.83-5.30) and occasional urinary incontinence (vs frequent; HR = 1.45; 95% CI = 1.18-1.78) were also important predictors. Dementia, diabetes, psychoactive drug use, and other characteristics were not associated with post-prescribing hip fracture. Predictors did not differ between bisphosphonate and calcitonin users.
Predictors of hip fracture among frail older adults did not differ between those who were new users of bisphosphonates vs calcitonin. Given the absence of risk factors unique to bisphosphonate users, targeting of fracture prevention efforts should extend beyond pharmacologic therapy to include existing nonpharmacologic therapies, particularly fall prevention strategies. J Am Geriatr Soc 68:256-260, 2020.
双膦酸盐能有效预防老年人髋部骨折，但许多患者在治疗过程中仍会骨折，可能需要额外的预防干预措施。针对双膦酸盐使用者的此类治疗目标，目前仅有少量特定数据。我们旨在确定在开始骨质疏松症药物治疗的体弱老年人中，髋部骨折的独特预测因素。
使用 2008-2013 年全国最低数据组评估、医疗保险索赔和疗养院（NH）设施数据进行回顾性队列研究。
美国的 NH。
65 岁或以上开始使用双膦酸盐（N=17753）治疗的长期 NH 居民。估计双膦酸盐使用者的预测因素与降钙素使用者（对照组；N=5348）的预测因素进行了对比。
使用 A 部分索赔来测量住院髋部骨折的结果。对 36 个预先选择的潜在预测因素进行了风险比（HR）和 95%置信区间（CI）的估计。
研究人群的平均（SD）年龄为 84（8）岁，85%为女性，51%有中度至重度认知障碍。尽管使用了双膦酸盐，但与髋部骨折风险增加相关的预测因素包括年龄≥75 岁至 85 岁（vs≥65 岁至<75 岁；HR=1.25；95%CI=1.02-1.55）、女性（HR=1.33；95%CI=1.06-1.67）、白人（vs 黑人；HR=1.87；95%CI=1.36-2.58）和体重指数为 18.5-24.9（vs≥30；HR=1.93；95%CI=1.53-2.42）。独立的转移能力（vs完全依赖；HR=3.11；95%CI=1.83-5.30）和偶尔的尿失禁（vs频繁；HR=1.45；95%CI=1.18-1.78）也是重要的预测因素。痴呆、糖尿病、精神活性药物使用和其他特征与处方后髋部骨折无关。在双膦酸盐和降钙素使用者之间，髋部骨折的预测因素没有差异。
在开始使用双膦酸盐或降钙素的体弱老年人中，髋部骨折的预测因素没有差异。鉴于没有针对双膦酸盐使用者的独特风险因素，骨折预防措施的目标应不仅限于药物治疗，还应包括现有的非药物治疗，特别是预防跌倒的策略。美国老年医学会 68:256-260，2020。
