Stephens Alastair, Rudd Hannah, Stephens Emilia, Ward Jayne
Trauma and Orthopaedic Department, University Hospital Coventry and Warwickshire, Coventry, United Kingdom.
JMIR Aging. 2020 Dec 22;3(2):e25607. doi: 10.2196/25607.
Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians.
This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population.
A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, "MRS BAD BONES," which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase.
Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (P=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (P=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (P=.003), bone-sparing medications to 72.4% (n=21) (P<.001), and DEXA scan requests to 60% (n=12) (P<.001).
The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The "MRS BAD BONES" mnemonic significantly improved management and could be used in a wider setting.
由于骨质疏松症所带来的发病率和死亡率，对于股骨颈骨折患者而言，骨质疏松症的管理是一项重要考量。骨科老年医学团队在协调继发性脆性骨折预防方面的作用至关重要。新冠疫情导致了医疗团队的迅速重组，并致使骨科老年医学专家被重新调配。
本研究旨在确定新冠疫情对股骨颈骨折患者脆性骨折二级预防的影响，并优化该人群的管理。
对英国因新冠疫情实施封锁前后的股骨颈骨折患者进行回顾性审计。在我们新的记忆法“MRS BAD BONES”制定后进行了重新审计，该记忆法涵盖了骨质疏松症评估和管理的关键因素：药物审查、风湿病/肾脏科建议、戒烟；血液检查、酒精限量、双能X线吸收法（DEXA）扫描；保骨药物、骨科老年医学评估、营养、运动、补充剂。采用Fisher精确检验进行各阶段之间的比较分析。
每个阶段均有50例患者的数据。封锁前，骨科老年医学团队对88%（n = 44）的患者进行了评估，由于人员重新调配，这一比例降至0%，之后在干预后期恢复到38%（n = 19）。封锁导致维生素D/钙补充剂的处方量显著下降，从81.6%（n = 40）降至58.0%（n = 29）（P = 0.02）；保骨药物的处方量从60.7%（n = 17）降至18.2%（n = 4）（P = 0.004），DEXA扫描申请从40.1%（n = 9）降至3.6%（n = 1）（P = 0.003）。在实施我们的记忆法后，维生素D/钙补充剂的处方量显著增加至85.7%（n = 42）（P = 0.003），保骨药物的处方量增加至72.4%（n = 21）（P < 0.001），DEXA扫描申请增加至60%（n = 12）（P < 0.001）。
由于新冠疫情导致的骨科老年医学团队重新调配，影响了研究人群中脆性骨折的二级预防。“MRS BAD BONES”记忆法显著改善了管理，可在更广泛的环境中使用。
