桡骨远端骨折后骨质疏松护理可减少后续髋部或脊柱骨折：一项 4 年纵向研究。
Osteoporosis care after distal radius fracture reduces subsequent hip or spine fractures: a 4-year longitudinal study.
机构信息
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
出版信息
Osteoporos Int. 2020 Aug;31(8):1471-1476. doi: 10.1007/s00198-020-05410-3. Epub 2020 Apr 16.
UNLABELLED
We evaluated whether active osteoporosis care in patients experiencing their first distal radius fracture (DRF) reduces subsequent hip or spine fractures by comparing two cohorts. The incidence of subsequent fractures was significantly lower in the active care cohort than the other cohort in 4-year follow-up.
PURPOSE
Studies show that osteoporosis care in patients with osteoporotic fracture reduces subsequent fractures, but the impact of such active care in patients with distal radius fracture (DRF) has not been well studied. We evaluated how much osteoporosis care in patients experiencing their first DRF can reduce subsequent hip or spine fractures at 4-year follow-up.
METHODS
Active osteoporosis care by orthopedic surgeons for patients with DRF started from September 2009 at our institution, thus we had a unique opportunity to compare the two cohorts: pre-involvement (PreI) group (DRF before September 2009) and post-involvement (PostI) group (DRF from September 2009). We compared the two cohorts for subsequent hip or spine fracture incidence in the 4 years following DRF.
RESULTS
Overall, 1057 patients with a DRF (85% women; mean age, 70 years) were studied, of whom 205 patients were in PreI group and 852 in PostI group. Subsequent fractures occurred in 27 patients (2.6%), with a mean interval of 29 months after DRF. The incidence was significantly lower in the PostI group than in the PreI group (1.9% vs. 5.4%, p = 0.004), especially in hip fractures (0.4% vs. 2.9%, p = 0.002). The relative risk reduction was 65% for all subsequent fractures and 86% for hip fractures.
CONCLUSION
This study demonstrates that active osteoporosis care in patients with DRF significantly reduces subsequent fracture incidence even for the 4-year follow-up period. These findings add an evidence for the current proactive osteoporosis care programs such as fracture liaison services.
LEVEL OF EVIDENCE
Therapeutic level III.
目的
研究表明，骨质疏松症骨折患者的骨质疏松症护理可降低随后发生的骨折，但尚未很好地研究初次桡骨远端骨折（DRF）患者的这种积极护理的影响。我们评估了在经历首次 DRF 的患者中进行骨质疏松症护理可以在 4 年随访时减少多少髋部或脊柱骨折。
方法
我们的机构从 2009 年 9 月开始由骨科医生为 DRF 患者提供积极的骨质疏松症护理，因此我们有机会比较两个队列：前期组（DRF 发生在 2009 年 9 月之前）和后期组（DRF 发生在 2009 年 9 月之后）。我们比较了两组患者在 DRF 后 4 年内发生髋部或脊柱骨折的发生率。
结果
共有 1057 例 DRF 患者（85%为女性；平均年龄 70 岁）入组，其中 205 例患者在前期组，852 例患者在后期组。有 27 例患者（2.6%）发生了后续骨折，平均在 DRF 后 29 个月出现。后期组的发生率明显低于前期组（1.9%比 5.4%，p=0.004），尤其是髋部骨折（0.4%比 2.9%，p=0.002）。所有后续骨折的相对风险降低了 65%，髋部骨折的相对风险降低了 86%。
结论
这项研究表明，DRF 患者的积极骨质疏松症护理显著降低了随后骨折的发生率，即使是在 4 年的随访期内。这些发现为当前的积极骨质疏松症护理计划（如骨折联络服务）提供了证据。
证据水平
治疗性 III 级。
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