Kwok T C Y, Law S W, Leung E M F, Choy D T K, Lam P M S, Leung J C S, Wong S H, Ip T P, Cheung C L
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong.
Hong Kong Med J. 2020 Jun;26(3):227-235. doi: 10.12809/hkmj198337.
Osteoporosis is highly prevalent but underdiagnosed and undertreated in Hong Kong. Fragility fractures associated with osteoporosis often result in loss of independence and increased mortality for home-dwelling patients, imposing a high socio-economic burden on society. This issue requires urgent attention given the rapid growth of the elderly population in Hong Kong by approximately 4.3% each year. To address this situation, a group of experts convened to discuss practical ways to reduce the burden of fractures and formulated three recommendations: first, all men (aged ≥70 years) and women (aged ≥65 years) should receive universal dual-energy X-ray absorptiometry assessment for osteoporosis. Second, all men (aged ≥70 years) and women (aged ≥65 years) with a fracture-risk assessment-derived 10-year risk (hip fracture with bone mineral density) ≥3% should receive ≥3 years of anti-osteoporotic treatment. Third, comprehensive structured assessment (including dual-energy X-ray absorptiometry) should be conducted in older patients with a history of falling. By implementing these recommendations, we estimate that we could prevent 5234 hip fractures in 10 years, an annual incidence reduction of approximately 7%, and save HK$425 million in direct medical costs plus substantial indirect savings. Ample clinical and cost-effectiveness data support these recommendations, and studies in Hong Kong and abroad could serve as models on how to implement them. We are confident that by applying these recommendations rigorously and systematically, a significant reduction in hip fractures in Hong Kong is achievable.
骨质疏松症在香港极为普遍，但诊断不足且治疗不充分。与骨质疏松症相关的脆性骨折常常导致居家患者失去独立生活能力并增加死亡率，给社会带来沉重的社会经济负担。鉴于香港老年人口以每年约4.3%的速度快速增长，这个问题亟待关注。为应对这种情况，一组专家齐聚一堂，讨论减轻骨折负担的切实可行方法，并制定了三项建议：第一，所有男性（年龄≥70岁）和女性（年龄≥65岁）都应接受骨质疏松症的通用双能X线吸收测定评估。第二，所有骨折风险评估得出的10年风险（基于骨密度的髋部骨折）≥3%的男性（年龄≥70岁）和女性（年龄≥65岁）都应接受≥3年的抗骨质疏松治疗。第三，应对有跌倒史的老年患者进行全面的结构化评估（包括双能X线吸收测定）。通过实施这些建议，我们估计在10年内可预防5234例髋部骨折，年发病率降低约7%，并节省4.25亿港元的直接医疗费用以及大量间接费用。大量临床和成本效益数据支持这些建议，香港及其他地区的研究可作为如何实施这些建议的范例。我们相信，通过严格且系统地应用这些建议，香港髋部骨折的发生率可大幅降低。
