Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention
Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention
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DOI：
10.1002/jbmr.1698
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发表时间：
2012-10-01
影响因子：
6.2
通讯作者：
Siris, Ethel
中科院分区：
文献类型：
--
作者：
Eisman, John A.;Bogoch, Earl R.;Siris, Ethel
脆性骨折很常见，几乎每两名老年女性中就有一名，每三名老年男性中就有一名。每一次脆性骨折都预示着未来骨折风险的增加以及过早死亡的风险。尽管在世界范围内产生了重大的医疗影响，但目前几乎没有系统可以在脆性骨折后识别和捕获个体，以确保适当的评估和治疗（根据国家指南），以减少未来的骨折风险和不良健康结果。工作组审查了目前关于不同系统性干预方法的证据，其逻辑背景以及医学和伦理学原理。这包括审查支持成本效益干预措施的证据，并开发一个工具包，以减少继发性骨折的发生率。本报告提供了具有成本效益的干预措施与未能解决进一步骨折相关的人力和医疗保健成本的证据。特别是，它总结了各种形式的骨折联络服务作为二级骨折预防的最有效干预措施的证据。它还总结了某些干预措施的证据，特别是那些基于病人和/或社区为重点的教育方法，是一贯的，如果出乎意料的，无效。作为一个代表亚太、南美洲、欧洲和北美洲36个国家的国际团体，工作队审查并总结了关于在实施减少风险战略方面遇到的障碍的国际数据。它提出了在骨质疏松症管理中提供高质量护理的伦理要求。作为实施战略的一部分，它描述了最适合转变护理的质量改进方法和仍然悬而未决的研究问题。工作队工作的首要成果是提供了支持二级骨折预防的合理背景和科学证据，并强调了在全世界实现这些高质量成果的一种或另一种形式的骨折联络服务的效用。(c)2012年美国骨与矿物质研究学会。
Fragility fractures are common, affecting almost one in two older women and one in three older men. Every fragility fracture signals increased risk of future fractures as well as risk of premature mortality. Despite the major health care impact worldwide, currently there are few systems in place to identify and capture individuals after a fragility fracture to ensure appropriate assessment and treatment (according to national guidelines) to reduce future fracture risk and adverse health outcomes. The Task Force reviewed the current evidence about different systematic interventional approaches, their logical background, as well as the medical and ethical rationale. This included reviewing the evidence supporting cost-effective interventions and developing a toolkit for reducing secondary fracture incidence. This report presents this evidence for cost-effective interventions versus the human and health care costs associated with the failure to address further fractures. In particular, it summarizes the evidence for various forms of Fracture Liaison Service as the most effective intervention for secondary fracture prevention. It also summarizes the evidence that certain interventions, particularly those based on patient and/or community-focused educational approaches, are consistently, if unexpectedly, ineffective. As an international group, representing 36 countries throughout Asia-Pacific, South America, Europe, and North America, the Task Force reviewed and summarized the international data on barriers encountered in implementing risk-reduction strategies. It presents the ethical imperatives for providing quality of care in osteoporosis management. As part of an implementation strategy, it describes both the quality improvement methods best suited to transforming care and the research questions that remain outstanding. The overarching outcome of the Task Force's work has been the provision of a rational background and the scientific evidence underpinning secondary fracture prevention and stresses the utility of one form or another of a Fracture Liaison Service in achieving those quality outcomes worldwide. (c) 2012 American Society for Bone and Mineral Research.