Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Health Economics and Outcomes Research, Global Medical Affairs, Radius Health, Inc., 22 Boston Wharf Road, 7th Floor, Boston, MA, 02210, USA.
Osteoporos Int. 2022 Apr;33(4):783-790. doi: 10.1007/s00198-021-06205-w. Epub 2021 Oct 23.
This study highlights an unmet need in osteoporosis management, suggesting that beyond bone mineral density and fracture history, gender, fracture type, and age should be considered for fracture risk assessment. Following fragility fracture, men, patients with a spine or hip fracture, and those aged ≥ 65 have a higher disease burden.
The objective of this study was to characterize osteoporosis-related fracture incidence and identify predictors of subsequent fractures and mortality.
This retrospective cohort study, conducted within Kaiser Permanente Southern California, included patients aged ≥ 50 years with qualifying fractures from 1/1/2007 to 12/31/2016, identified from diagnosis/procedure codes. Rates for fracture incidence, mortality, and resource utilization in the year post-fracture are reported. Associations between index fracture types and demographic/clinical characteristics, and mortality, subsequent fracture, and rehospitalization outcomes were estimated.
Of 63,755 eligible patients, 66.7% were ≥ 65 years and 69.1% female. Index fractures included nonhip/nonspine (64.4%), hip (25.3%), and spine (10.3%). Age-adjusted subsequent fracture rate/100 person-years was higher for those with an index spine (14.5) versus hip fracture (6.3). Hospitalization rate/100 person-years was highest for patients ≥ 65 (31.8) and for spine fractures (43.5). Men (vs women) had higher age-adjusted rates of hospitalization (19.4; 17.7), emergency room visits (73.8; 66.3), and use of rehabilitation services (31.7; 27.2). The 30-day age-adjusted mortality rate/100 person-years was 46.7, 32.4, and 15.5 for spine, hip, and nonspine/nonhip fractures. The 1-year age-adjusted mortality rate/100 person-years was 14.7 for spine and 15.6 for hip fractures. In multivariable analyses, spine and hip fractures (vs nonhip/nonspine fractures) were significant predictors of 1-year mortality, all-cause and osteoporosis-related hospitalization, and nursing home use (all P-values < 0.0001).
Morbidity is high in the year following a fragility fracture and men, patients with a spine or hip fracture, and those aged ≥ 65 have a greater disease burden.
本研究强调了骨质疏松症管理中的未满足需求，表明在考虑骨折风险评估时，除了骨密度和骨折史外，还应考虑性别、骨折类型和年龄。脆性骨折后，男性、脊柱或髋部骨折患者以及年龄≥65 岁的患者疾病负担更高。
这是一项在凯撒永久南加州进行的回顾性队列研究，纳入了 2007 年 1 月 1 日至 2016 年 12 月 31 日期间因符合条件的骨折而从诊断/手术代码中识别出的≥50 岁的患者。报告了骨折后一年内的骨折发生率、死亡率和资源利用情况。评估了索引骨折类型与人口统计学/临床特征以及死亡率、随后骨折和再入院结局之间的关系。
在脆性骨折后一年，发病率较高，男性、脊柱或髋部骨折患者以及年龄≥65 岁的患者疾病负担更大。
