Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan.
Department of Rehabilitation Medicine, Yokohama City University Medical Center, Kanagawa, Japan.
J Orthop Sci. 2021 May;26(3):448-452. doi: 10.1016/j.jos.2020.03.015. Epub 2020 Apr 16.
Potentially inappropriate medications (PIMs) are a major concern in geriatric care. Osteoporotic vertebral compression fractures (OVCFs) are more common among the elderly, who are more likely to receive long-term analgesics for pain and additional medications for complications, but no studies have examined the effects of PIMs on OVCFs. The purpose of our study was to clarify the association between PIMs and activities of daily living (ADL) among patients with OVCFs.
The subjects were 170 patients aged 65 years or older with OVCFs treated conservatively who underwent rehabilitation between October 2014 and August 2019. Patients' clinical information, including age, sex, body mass index, total number of drugs used for treatment at admission, number and type of PIMs used at admission, bone mineral density, use of drugs for osteoporosis, fracture type, comorbidity severity, nutritional status, Barthel Index (BI), presence and extent of lower back pain, and length of hospital stay were examined retrospectively. The possible association between these clinical factors and the BI and use of PIMs was assessed.
Ninety-seven patients (57.1%) were prescribed PIMs at admission. Mean BI at discharge was significantly lower among patients receiving PIMS (70 points vs. 83 points; p < 0.001). Multivariate analysis for BI gain after propensity score matching showed that the number of PIMs and BI at admission affected the BI gain.
The use of PIMs hindered the improvement in ADL. Our results demonstrate the importance of appropriate drug control for patients with OVCFs.
不适当药物(PIMs)是老年医学护理中的一个主要关注点。骨质疏松性椎体压缩性骨折(OVCFs)在老年人中更为常见,他们更有可能因疼痛而长期接受镇痛药,以及因并发症而接受其他药物治疗,但目前尚无研究探讨 PIMs 对 OVCFs 的影响。我们研究的目的是阐明 PIMs 与 OVCFs 患者日常生活活动(ADL)之间的关联。
本研究纳入了 170 名年龄在 65 岁及以上、接受保守治疗的 OVCFs 患者,这些患者在 2014 年 10 月至 2019 年 8 月期间接受了康复治疗。回顾性分析了患者的临床信息,包括年龄、性别、体重指数、入院时治疗用药物总数、入院时使用的 PIM 数量和类型、骨密度、骨质疏松症药物使用情况、骨折类型、合并症严重程度、营养状况、Barthel 指数(BI)、下腰痛的存在和严重程度以及住院时间。评估了这些临床因素与 BI 和 PIM 使用之间的可能关联。
97 名患者(57.1%)在入院时被开具了 PIMs。使用 PIMs 的患者出院时的 BI 明显较低(70 分 vs. 83 分;p<0.001)。经倾向评分匹配后对 BI 改善的多变量分析显示,PIM 数量和入院时的 BI 影响 BI 的改善。
使用 PIMs 会阻碍 ADL 的改善。我们的研究结果表明,对 OVCFs 患者进行适当的药物控制非常重要。