Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Bone. 2022 Jan;154:116216. doi: 10.1016/j.bone.2021.116216. Epub 2021 Sep 25.
Mortality after osteoporotic hip fractures is high. Postoperative care is as important as surgery itself to prevent a second fracture and improve outcomes, and the effect of anti-osteoporosis treatment after hip fractures on overall mortality is controversial. This nationwide population study aimed to determine whether anti-osteoporosis treatment might reduce overall mortality after hip fracture surgery.
We conducted this cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan to identify patients admitted for surgery due to hip fractures from 2008 to 2018. The subsequent use and duration of anti-osteoporotic medication and other parameters were analyzed, and national death registration records were retrieved to investigate mortality.
A total of 59,943 patients admitted for hip fracture surgery were identified. The 22,494 patients (37.5%) who received anti-osteoporotic medication showed a lower all-cause mortality rate compared with the 37,449 patients (62.5%) who did not receive further treatment (hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.67-0.70, p < 0.0001). Patients who received anti-osteoporotic medication for more than 1, 2, and 3 years exhibited propotional reductions in all-cause mortality (HR & 95%CI: 0.57 (0.54-0.60), 0.42 (0.38-0.46), and 0.29 (0.26-0.33) respectively).
Anti-osteoporosis treatment was associated with lower all-cause mortality after hip fracture surgery. A longer duration of treatment was also associated with lower mortality. Postoperative treatment for osteoporosis is crucial for patients with hip fracture.
骨质疏松性髋部骨折的死亡率较高。术后护理与手术本身同样重要，可以预防再次骨折并改善预后，而髋部骨折后抗骨质疏松治疗对总体死亡率的影响存在争议。本项全国性人群研究旨在确定抗骨质疏松治疗是否可以降低髋部骨折手术后的总体死亡率。
我们使用台湾全民健康保险研究数据库（NHIRD）进行了这项队列研究，以确定 2008 年至 2018 年期间因髋部骨折住院接受手术的患者。分析了随后使用和持续时间的抗骨质疏松药物以及其他参数，并检索了全国死亡登记记录以调查死亡率。
共确定了 59943 例接受髋部骨折手术的患者。与未接受进一步治疗的 37449 例患者（62.5%）相比，接受抗骨质疏松药物治疗的 22494 例患者（37.5%）的全因死亡率较低（风险比（HR）：0.69，95%置信区间（CI）：0.67-0.70，p<0.0001）。接受抗骨质疏松药物治疗超过 1、2 和 3 年的患者全因死亡率呈比例降低（HR 和 95%CI：0.57（0.54-0.60），0.42（0.38-0.46）和 0.29（0.26-0.33））。
髋部骨折手术后，抗骨质疏松治疗与全因死亡率降低相关。治疗时间的延长也与死亡率降低相关。髋部骨折患者术后骨质疏松治疗至关重要。
