Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Arch Osteoporos. 2020 Feb 22;15(1):20. doi: 10.1007/s11657-020-0690-2.
Osteoporosis is the most common condition contributing to 95% of fractures in older patients hospitalized for fracture treatment. Despite the significant impact of fragility fractures on patient morbidity and mortality, efforts in optimizing osteoporotic treatment and prevention remain inadequate. In contrast, in patients with limited life expectancy, withholding specific osteoporosis drug treatment appears reasonable. The threshold between under- and overtreatment is still unclear.
In 2016, we implemented a fracture liaison service (FLS) for 18 months to improve the quality of osteoporosis care. We collected prospectively the patient's history, current treatment for osteoporosis, and risk factors for fragility fractures using a standardized protocol. Recommendations for drug therapy are discussed during the interdisciplinary ward round. The primary outcome parameter was a recommendation for specific osteoporosis drug treatment. We included 681 patients (mean age 82.5 years, 502 (73.7%) females). The inclusion criteria were the following: age of 70 years or older, admission to geriatric fracture center between April 2016 and December 2018.
Based on our data, specific osteoporosis drug therapy was recommended in 467 (68.6%) patients. Six hundred fifty-one (95.6%) patients received vitamin D3, and 546 (80.2%) calcium. After adjustment, only age (every 5 years, OR 0.57; 95% CI 0.45-0.72; p < 0.0001), cognitive impairment (OR 0.41; 95% CI 0.23-0.74; p = 0.003), pre-fracture mobility (OR 1.54; 95% CI 1.34-1.75; p < 0.0001), and living in a nursing home (OR 0.52; 95% CI 0.27-0.99; p = 0.049) remained as independent predictors for an indication of specific osteoporosis drug therapy.
We found a higher rate of recommendations for specific osteoporosis drug therapy compared with usual treatment rates in literature. Though in some cases withholding of specific osteoporosis drug therapy seems reasonable, the main proportion of fragility fracture patients is undertreated. Our results could be a benchmark for the quality of osteoporosis care in older fragility fracture patients treated in a geriatric fracture center.
骨质疏松症是导致老年住院骨折患者骨折的最常见原因，占 95%。尽管脆性骨折对患者的发病率和死亡率有重大影响，但在优化骨质疏松治疗和预防方面的努力仍不足。相比之下，在预期寿命有限的患者中，不使用特定的骨质疏松药物治疗似乎是合理的。但过度治疗和治疗不足的界限仍不明确。
我们在 2016 年实施了骨折联络服务（FLS），以提高骨质疏松症护理质量。我们使用标准化方案前瞻性地收集患者病史、当前骨质疏松症治疗和脆性骨折风险因素。在跨学科病房查房期间讨论药物治疗建议。主要观察指标为是否建议使用特定的骨质疏松症药物治疗。共纳入 681 例患者（平均年龄 82.5 岁，502 例[73.7%]为女性）。纳入标准为：年龄≥70 岁，2016 年 4 月至 2018 年 12 月期间入住老年骨折中心。
根据我们的数据，467 例（68.6%）患者建议使用特定的骨质疏松症药物治疗。651 例（95.6%）患者接受了维生素 D3 治疗，546 例（80.2%）患者接受了钙治疗。经调整后，仅年龄（每增加 5 岁，OR 0.57；95%CI 0.45-0.72；p<0.0001）、认知障碍（OR 0.41；95%CI 0.23-0.74；p=0.003）、骨折前活动能力（OR 1.54；95%CI 1.34-1.75；p<0.0001）和居住在疗养院（OR 0.52；95%CI 0.27-0.99；p=0.049）仍是特定骨质疏松症药物治疗指征的独立预测因素。
与文献中通常的治疗率相比，我们发现建议使用特定骨质疏松症药物治疗的比率更高。尽管在某些情况下不使用特定的骨质疏松症药物治疗似乎是合理的，但大部分脆性骨折患者的治疗不足。我们的研究结果可以作为老年脆性骨折患者在老年骨折中心接受骨质疏松症治疗的质量基准。
