Osteoporosis Medications Prevent Subsequent Fracture in Frail Older Adults.
Osteoporosis Medications Prevent Subsequent Fracture in Frail Older Adults.
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骨质疏松症药物可预防体弱老年人的后续骨折。
DOI：
10.1002/jbmr.4693
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发表时间：
2022-11
影响因子：
6.2
通讯作者：
Berry, Sarah D.
中科院分区：
文献类型：
--
作者：
Chattaris, Tanchanok;Oh, Gahee;Gouskova, Natalia A.;Kim, Dae Hyun;Kiel, Douglas P.;Berry, Sarah D.
虚弱在有骨折的老年人中很常见。骨质疏松症药物减少随后的骨折，但有限的数据存在的药物疗效虚弱的个人。我们的目的是确定药物是否能降低体弱老年人随后发生骨折的风险。对医疗保险按服务收费受益人进行了回顾性队列研究（2014-2016）。我们纳入了年龄≥ 65岁、因骨折住院但未接受骨质疏松治疗的成人。使用基于索赔的虚弱指数（≥ 0.2 =虚弱）定义骨折前虚弱。使用B和D部分声明确定任何骨质疏松症治疗（口服或静脉注射双膦酸盐、地舒单抗和特立帕肽）的暴露，并根据累积暴露持续时间进行分类：无、1-90天和> 90天。从A部分或B部分索赔中确定了随后的断裂。随时间变化的暴露的原因特异性风险模型适合于检查治疗和骨折结果之间的关联，控制相关的协变量。在29，904例因骨折住院的患者中，15，345例（51.3%）虚弱，2，148例（7.2%）接受骨质疏松治疗（中位治疗持续时间为183.0天）。与未接受治疗的患者相比，接受治疗的患者更年轻（80.2 vs 82.2岁），女性（86.5% vs 73.0%），体弱（0.20 vs 0.22）。随访期间，5，079例（17.0%）患者发生了后续骨折。与未治疗相比，骨质疏松症药物治疗> 90天可降低骨折风险（HR 0.82，95% CI 0.68-1.00）。虚弱（HR 0.85; 95% CI 0.65-1.12）和非虚弱（HR 0.80; 95% CI 0.61-1.04）患者的结果相似，但不显著。总之，骨质疏松症治疗> 90天与虚弱和非虚弱人群随后骨折风险降低的趋势相似。治疗率非常低，特别是在体弱者中。在权衡住院骨折的虚弱老年人的治疗选择时，临床医生应该意识到药物治疗似乎不会失去疗效。
Frailty is common in older adults with fractures. Osteoporosis medications reduce subsequent fracture, but limited data exist on medication efficacy in frail individuals. Our objective was to determine whether medications reduce the risk of subsequent fracture in frail, older adults. A retrospective cohort of Medicare fee-for-service beneficiaries was conducted (2014–2016). We included adults aged ≥ 65 years who were hospitalized with fractures without osteoporosis treatment. Pre-fracture frailty was defined using claims-based frailty index (≥ 0.2 = frail). Exposure to any osteoporosis treatment (oral or intravenous bisphosphonates, denosumab, and teriparatide) was ascertained using Part B and D claims and categorized according to the cumulative duration of exposure: none, 1–90 days, and > 90 days. Subsequent fractures were ascertained from Part A or B claims. Cause-specific hazard models with time-varying exposure were fit to examine the association between treatment and fracture outcomes, controlling for relevant covariates. Among 29,904 patients hospitalized with fractures, 15,345 (51.3%) were frail, and 2,148 (7.2%) received osteoporosis treatment (median treatment duration 183.0 days). Patients who received treatment were younger (80.2 vs 82.2 years), female (86.5% vs 73.0%), less frail (0.20 vs 0.22) than patients without treatment. During follow-up, 5,079 (17.0%) patients experienced a subsequent fracture. Treatment with osteoporosis medications for > 90 days compared to no treatment reduced the risk of fracture (HR 0.82, 95% CI 0.68–1.00) overall. Results were similar in frail (HR 0.85; 95% CI 0.65–1.12) and non-frail (HR 0.80; 95% CI 0.61–1.04) patients, but not significant. In conclusion, osteoporosis treatment > 90 days was associated with similar trends in reduced risk of subsequent fracture in frail and non-frail persons. Treatment rates were very low, particularly among the frail. When weighing treatment options in frail older adults with hospitalized fractures, clinicians should be aware that drug therapy does not appear to lose its efficacy.
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影响因子：
158.5
作者：
Lyles, Kenneth W.;Colon-Emeric, Cathleen S.;Boonen, Steven
通讯作者：
Boonen, Steven
影响因子：
4.7
作者：
Curtis, Jeffrey R.;Yun, Huifeng;Matthews, Robert;Saag, Kenneth G.;Delzell, Elizabeth
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影响因子：
4
作者：
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Nordstrom, P.
影响因子：
5.8
作者：
Boonen, S.;Adachi, J. D.;McClung, M.
通讯作者：
McClung, M.
影响因子：
5.8
作者：
Center, Jacqueline R.;Bliuc, Dana;Eisman, John A.
通讯作者：
Eisman, John A.