Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Graz, Austria.
Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden.
Bone. 2021 Jan;142:115071. doi: 10.1016/j.bone.2019.115071. Epub 2019 Oct 5.
Despite availability of effective treatment options proven to prevent osteoporotic fractures, a huge gap in osteoporosis treatment exists. The aim of the present study was to evaluate the treatment rate after a major osteoporotic fracture (MOF) in Austria, one of the 25 wealthiest countries worldwide.
This analysis is based on the data of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS), a prospective observational study assessing data from patients who suffered a MOF. We stratified these patients by treatment status at time of fracture and compared treatment use following MOF by sex as well as by fracture sites at the time of the index fracture, and 4, 12, and 18 months thereafter. Descriptive statistics, t-tests for continuous variables and chi-squared tests for nominal variables, were performed to compare treatment groups.
A total of 915 patients (78 % female) were recruited at 8 different trauma centers throughout Austria. At the time of fracture, 731 patients (80 %) did not receive osteoporosis treatment. In this group, follow-up analysis after 4, 12 and 18 months revealed a treatment rate of 18 %, 16 %, 15 % in women, and 8 %, 12 %, 10 % in men, respectively. In those who received osteoporosis medication at the time of fracture the treatment rate was 65 %, 54 % and 60 % in women, and comparable results in men.
Only 1 in 10 men, and less than 2 in 10 women of those who did not receive osteoporosis treatment at the time of fracture were prescribed an adequate osteoporosis treatment. Thus, the vast majority of patients who sustained an osteoporotic fracture and thus were at imminent risk of receiving subsequent fractures did not receive an adequate treatment. There is a clear need for the implementation of coordinated, multi-disciplinary models of care for secondary fracture prevention.
尽管有已被证实可预防骨质疏松性骨折的有效治疗方法，但骨质疏松症的治疗仍存在巨大差距。本研究旨在评估在全球 25 个最富裕国家之一的奥地利，发生重大骨质疏松性骨折（MOF）后的治疗率。
本分析基于国际骨质疏松性骨折成本和效用相关研究（ICUROS）的数据，这是一项前瞻性观察性研究，评估了发生 MOF 患者的数据。我们根据骨折时的治疗情况对这些患者进行分层，并按性别以及指数骨折时的骨折部位以及此后 4、12 和 18 个月比较 MOF 后的治疗使用情况。使用连续变量的 t 检验和名义变量的卡方检验对治疗组进行比较。
共在奥地利 8 家不同创伤中心招募了 915 名患者（78%为女性）。在骨折时，731 名患者（80%）未接受骨质疏松症治疗。在该组中，4、12 和 18 个月后的随访分析显示，女性的治疗率分别为 18%、16%、15%，男性分别为 8%、12%、10%。在骨折时接受骨质疏松药物治疗的患者中，女性的治疗率分别为 65%、54%和 60%，男性的结果相当。
在未接受骨折时骨质疏松症治疗的患者中，仅有 1/10 的男性和不到 2/10 的女性接受了适当的骨质疏松症治疗。因此，绝大多数发生骨质疏松性骨折且因此面临随后骨折风险的患者未接受适当的治疗。显然需要实施协调的、多学科的二级骨折预防护理模式。
