Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
Australian and New Zealand Hip Fracture Registry Steering Group, Auckland, New Zealand.
Arch Osteoporos. 2022 Dec 12;18(1):8. doi: 10.1007/s11657-022-01197-4.
Pharmacological management of bone health warrants investigation into factors influencing initiation of bone protection medication (BPM) at discharge after a hip fracture. This sprint audit identified reasons attributed to low BPM treatment levels at hospital discharge which can guide improvement in the prevention of future fractures.
To compare patient characteristics and Australian and New Zealand approaches to prescribing bone protection medication (BPM) pre- or post-hip fracture, determine reasons why BPM was not prescribed earlier post-fracture, and assess the generalisability of sprint audit and the Australian and New Zealand Hip Fracture Registry (ANZHFR) patient cohorts.
A retrospective cohort study of hip fracture patients from the ANZHFR aged ≥ 50 years (2016-2020) and consecutive patients from the 2021 BPM sprint audit. Multivariable logistic regression was used to examine factors associated with not prescribing BPM.
Of 55,618 patients admitted with a hip fracture in the ANZHFR, less than 10% of patients in Australia and New Zealand were taking BPM on admission, increasing to 22.4% in Australia and 27.8% in New Zealand on discharge. Registry patients who were younger (50-69 years), healthy (ASA grade 1), lived in a residential aged care facility, had impaired cognition, delirium identified, or were awaiting a specialist falls assessment were less likely to take BPM. Within the audit, 46.2% of patients in Australia and 39.2% in New Zealand did not have BPM in their discharge prescription. The most common reason for not prescribing BPM in Australia was low level of vitamin D (13.3%), and in New Zealand, renal impairment (14.8%). Sprint and registry patient characteristics were comparable in terms of patient age, sex, usual place of residence, and ASA grade.
BPM prescription early after hip fracture is low. Opportunities exist to increase the rate of prescription of medications known to prevent future fractures in this high-risk population.
比较澳大利亚和新西兰髋部骨折患者骨折前或骨折后使用骨保护药物（BPM）的患者特征和方法，确定骨折后早期未开具 BPM 的原因，并评估冲刺审计和澳大利亚和新西兰髋部骨折登记处（ANZHFR）患者队列的普遍性。
对 2016-2020 年 ANZHFR 中年龄≥50 岁的髋部骨折患者进行回顾性队列研究，并对 2021 年 BPM 冲刺审计的连续患者进行研究。多变量逻辑回归用于检查与未开具 BPM 相关的因素。
在 ANZHFR 中，55618 名髋部骨折患者中，不到 10%的患者在入院时服用 BPM，澳大利亚和新西兰的患者在出院时分别增加到 22.4%和 27.8%。登记处患者年龄较小（50-69 岁）、健康（ASA 分级 1）、居住在养老院、认知障碍、有谵妄、正在接受专家跌倒评估的患者服用 BPM 的可能性较低。在审计中，澳大利亚有 46.2%的患者和新西兰有 39.2%的患者出院处方中没有 BPM。在澳大利亚，不开具 BPM 的最常见原因是维生素 D 水平低（13.3%），而在新西兰，原因是肾功能损害（14.8%）。冲刺和登记处患者的特征在患者年龄、性别、常住地和 ASA 分级方面相似。
髋部骨折后早期 BPM 的开具率较低。在这个高危人群中，有机会增加预防未来骨折的药物的开具率。
