Daskalakis Ioannis I, Kritsotakis Evangelos I, Bastian Johannes D, Sperelakis Ioannis V, Tosounidis Theodoros H
Department of Orthopaedic Surgery, University Hospital of Heraklion, 71500, Heraklion, Crete, Greece.
Laboratory of Biostatistics, Medical School, University of Crete, Heraklion, Greece.
Arch Orthop Trauma Surg. 2025 Jun 30;145(1):358. doi: 10.1007/s00402-025-05974-x.
Secondary fracture prevention is essential to current hip fracture management. However, many patients are discharged without the appropriate anti-osteoporotic medication (AOM). This study aims to evaluate the impact of the implementation of an in-hospital, surgeon-led AOM algorithm on patients with fragility hip fractures. The three outcome events of interest assessed were (a) the AOM initiation (b) the persistence to medication at 2 years of follow-up and (c) the secondary fracture incidence within 2 years of AOM initiation in the treated and control groups.
This was a three-arm controlled before-after quasi-experimental study. A group of hospitalized patients with low-energy hip fractures who were prescribed AOM according to the surgeon-led AO algorithm between March 2020 and May 2022, were compared with a group of concurrent control patients who refused the treatment over the same 2 year period, and a group of historical control patients who were hospitalized for hip fragility fractures in 2 years before the algorithm was introduced (February 2018 to February 2020). AOM initiation rates, 2 year medication persistence, and risks of secondary osteoporotic fracture were assessed and compared between groups.
In this study, we enrolled 598 patients (mean age 82 ± 8 years, 78% female). Post-fracture AOM initiation increased from 15% (41/281) before to 67% (213/317) after introducing the algorithm. Medication persistence after 2 years of AOM initiation was 56% (95% confidence interval [CI] 49-63%) in treated patients and 52% (95% CI 36-66%) in historical controls. Secondary osteoporotic fractures occurred in 15/213 (7%) treated patients, 8/104 (8%) concurrent control patients, and 20/281 (7%) historical-control patients over an average follow-up of 20.4 months. Multivariable Cox regression analysis did not demonstrate significantly different fracture risks in historical controls (cause-specific hazard ratio [csHR] 0.92; 95%CI 0.45-1.89) or concurrent controls (csHR 1.08; 95% CI 0.45-2.57) compared to treated patients.
The AO Foundation algorithm can increase AOM initiation at hospital discharge, retaining high medication persistence 2 years post-fracture. A longer follow-up period is required to evaluate the algorithm's effect on secondary fracture prevention.
继发性骨折预防对于当前的髋部骨折治疗至关重要。然而，许多患者出院时未使用适当的抗骨质疏松药物（AOM）。本研究旨在评估实施由外科医生主导的院内AOM算法对脆性髋部骨折患者的影响。评估的三个感兴趣的结局事件为：（a）AOM起始；（b）随访2年时的药物持续使用情况；（c）治疗组和对照组中AOM起始后2年内的继发性骨折发生率。
这是一项三臂前后对照的准实验研究。将2020年3月至2022年5月期间根据外科医生主导的AO算法开具AOM处方的一组住院低能量髋部骨折患者，与同期拒绝治疗的一组对照患者，以及在该算法引入前2年（2018年2月至2020年2月）因髋部脆性骨折住院的一组历史对照患者进行比较。评估并比较各组的AOM起始率、2年药物持续使用率和继发性骨质疏松性骨折风险。
本研究共纳入598例患者（平均年龄82±8岁，78%为女性）。骨折后AOM起始率从引入算法前的15%（41/281）增至引入算法后的67%（213/317）。AOM起始2年后，治疗组患者的药物持续使用率为56%（95%置信区间[CI]49 - 63%），历史对照组为52%（95%CI 36 - 66%）。在平均20.4个月的随访期内，15/213（7%）例治疗组患者、8/104（8%）例同期对照患者和20/281（7%）例历史对照患者发生继发性骨质疏松性骨折。多变量Cox回归分析显示，与治疗组患者相比，历史对照组（病因特异性风险比[csHR]0.92；95%CI 0.45 - 1.89）或同期对照组（csHR 1.08；95%CI 0.45 - 2.57）的骨折风险无显著差异。
AO基金会算法可提高出院时的AOM起始率，骨折后2年保持较高的药物持续使用率。需要更长的随访期来评估该算法对继发性骨折预防的效果。
