University Hospital of Wales and College of Medicine, Cardiff University, Cardiff CF14 4XW, UK.
Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London NW1 4LE, UK.
Age Ageing. 2023 Sep 1;52(9). doi: 10.1093/ageing/afad172.
Currently in the UK and Ireland, after a hip fracture most patients do not receive bone protection medication to reduce the risk of refracture. Yet randomised controlled trial data specifically examining patients with hip fracture have shown that intravenous zoledronate reduces refracture risk by a third. Despite this evidence, use of intravenous zoledronate is highly variable following a hip fracture; many hospitals are providing this treatment, whilst most are currently not. A range of clinical uncertainties, doubts over the evidence base and practical concerns are cited as reasons. This paper discusses these concerns and provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital, in order to reduce costly re-fractures in this frail population.
目前在英国和爱尔兰，大多数髋部骨折患者在骨折后都没有接受骨保护药物治疗，以降低再次骨折的风险。然而，专门针对髋部骨折患者的随机对照试验数据表明，静脉唑来膦酸盐可使再次骨折的风险降低三分之一。尽管有这方面的证据，但髋部骨折后静脉唑来膦酸盐的使用存在很大的差异；许多医院都在提供这种治疗，而大多数医院目前则没有。人们引用了一系列临床不确定性、对证据基础的疑虑和实际问题，作为不使用该药物的原因。本文讨论了这些顾虑，并从专家共识的角度提供了指导，旨在帮助矫形外科医生、药剂师和卫生服务管理人员在患者出院前制定当地的治疗方案，为他们提供这种具有高度临床和成本效益的治疗，以减少这一脆弱人群中昂贵的再次骨折。
