Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China.
Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, Jiangsu, China.
Osteoporos Int. 2024 Jan;35(1):53-67. doi: 10.1007/s00198-023-06905-5. Epub 2023 Sep 12.
We examined the performance of an intelligent fracture liaison service (FLS) assisted by digital health (DH) to reduce all-cause mortality (ACM) risk. According to our findings, the new FLS reduced ACM by 36%.
A well-designed secondary prevention program known as FLS enhances the bone densitometry-based assessment rate as well as osteoporosis (OP) medication usage following a fracture. However, there are only a few reports on FLS incorporating DH, and it remains unclear whether this integration has influenced patient ACM, which refers to the overall death rate from any cause during the study period.
This retrospective observational study was conducted on data from the Fragility Fracture Registration System database linked to the Regional Health Registration Platform of Kunshan City and the Population Death Registration System of Jiangsu Province for one tertiary-level A hospital in China. Patients aged ≥ 50 years, who experienced an OP fracture between January 1, 2017, and July 27, 2022, requiring hospitalization, were selected for analysis. We compared the outcomes of patients who received routine fragility fracture management (the no-FLS group) or FLS (the FLS group). We employed multivariable Cox regression with inverse probability weighting based on the propensity score (PS).
Of 2317 patients, 756 (32.6%) received FLS and 1561 (67.4%) did not. Using PS matching, we minimized the baseline characteristic differences between the two groups in the propensity score-matched samples, relative to the unmatched samples. Based on our analysis, the new FLS reduced ACM by 36% (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.47 to 0.87; P-value = 0.004). Moreover, FLS patients experienced further reductions in fall-related mortality, refracture rate, and total refracture-related hospital costs, and had increased dual-energy X-ray absorptiometry (DXA) testing and treatment initiation rates, relative to the no-FLS patients.
A new FLS model implementation assisted by DH can effectively reduce ACM among elderly patients with OP fractures requiring surgery. In future investigations, we recommend examining the scalability of this model.
我们研究了数字健康辅助下的智能骨折联络服务（FLS）在降低全因死亡率（ACM）风险方面的表现。结果显示，新的 FLS 将 ACM 降低了 36%。
一项设计良好的二级预防计划，即 FLS，可提高基于骨密度测定的评估率以及骨折后骨质疏松症（OP）药物的使用。然而，目前只有少数关于纳入数字健康的 FLS 的报告，尚不清楚这种整合是否影响了患者的 ACM，ACM 是指研究期间任何原因导致的总死亡率。
这是一项在中国一家三级医院的脆性骨折登记系统数据库与昆山市区域健康登记平台和江苏省人口死亡登记系统链接的回顾性观察性研究。选择 2017 年 1 月 1 日至 2022 年 7 月 27 日期间因 OP 骨折住院的≥50 岁患者进行分析。比较接受常规脆性骨折管理（无 FLS 组）或 FLS（FLS 组）的患者的结局。我们采用基于倾向评分（PS）的逆概率加权多变量 Cox 回归。
在 2317 名患者中，756 名（32.6%）接受了 FLS，1561 名（67.4%）未接受 FLS。使用 PS 匹配，我们在倾向评分匹配样本中最小化了两组之间的基线特征差异，与未匹配样本相比。根据我们的分析，新的 FLS 将 ACM 降低了 36%（风险比 [HR]，0.64；95%置信区间 [CI]，0.47 至 0.87；P 值=0.004）。此外，与无 FLS 患者相比，FLS 患者的跌倒相关死亡率、再骨折率和总再骨折相关住院费用进一步降低，双能 X 线吸收法（DXA）检测和治疗开始率更高。
数字健康辅助下的新型 FLS 模型的实施可以有效降低需要手术的老年 OP 骨折患者的 ACM。在未来的研究中，我们建议检查该模型的可扩展性。
