Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2022 Dec 1;17(12):e0278368. doi: 10.1371/journal.pone.0278368. eCollection 2022.
Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture.
A cohort of patients with a hip fracture between 2016-2018 was assembled from the American College of Surgeons National Surgical Quality Improvement Program registry. Patients on anti-osteoporosis medications prior to admission were excluded. Multivariable logistic regression was used to determine adjusted associations between patient age, sex and race and their interactions with prescription of anti-osteoporosis medications within 30 days of surgery.
In total, 12,249 patients with a hip fracture were identified with a median age of 82 years (IQR: 73-87), and 67% were female (n = 8,218). Thirty days postoperatively, 26% (n = 3146) of patients had been prescribed anti-osteoporosis medication. A significant interaction between age and sex with medication prescription was observed (p = 0.04). Male patients in their 50s (OR:0.75, 95%CI:0.60-0.92), 60s (OR:0.81, 95%CI:0.70-0.94) and 70s (OR:0.89, 95%CI:0.81-0.97) were less likely to be prescribed anti-osteoporosis medication compared to female patients of the same age. Patients who belonged to minority racial groups were not less likely to receive anti-osteoporosis medications than patients of white race.
Only 26% of patients were prescribed anti-osteoporosis medications following hip fracture, despite consensus guidelines urging early initiation of secondary prevention treatments. Given that prescription varied by age and sex, strategies to prevent disparities in secondary fracture prevention are warranted.
髋部骨折后开始使用抗骨质疏松药物可降低随后发生脆性骨折的风险。针对某些群体进行二级骨折预防的历史偏见可能导致治疗差异。我们研究了患者年龄、性别和种族与髋部骨折后抗骨质疏松药物处方之间的关系。
从美国外科医师学会国家手术质量改进计划登记处收集了 2016 年至 2018 年间髋部骨折患者的队列。排除入院前使用抗骨质疏松药物的患者。使用多变量逻辑回归确定患者年龄、性别和种族及其与术后 30 天内抗骨质疏松药物处方之间的调整关联，并进行交互作用分析。
共确定了 12249 例髋部骨折患者，中位年龄为 82 岁（IQR：73-87），67%为女性（n=8218）。术后 30 天，26%（n=3146）的患者开具了抗骨质疏松药物。年龄和性别与药物处方之间存在显著的交互作用（p=0.04）。50 多岁的男性患者（OR：0.75，95%CI：0.60-0.92）、60 多岁的男性患者（OR：0.81，95%CI：0.70-0.94）和 70 多岁的男性患者（OR：0.89，95%CI：0.81-0.97）与同年龄的女性患者相比，不太可能开具抗骨质疏松药物。属于少数族裔的患者与白人患者相比，接受抗骨质疏松药物治疗的可能性没有降低。
尽管有共识指南敦促早期开始二级预防治疗，但只有 26%的髋部骨折患者接受了抗骨质疏松药物治疗。鉴于处方存在差异，需要制定策略来预防二级骨折预防中的差异。
