北京地区老年髋部脆性骨折患者术后抗骨质疏松症药物治疗现状及影响因素分析  

The status and influencing factors of anti-osteoporosis medication treatment after hip fragility fractures in elderly patients in Beijing area

作　　者：彭卫东 刘刚[1] 葛宇峰 谭哲伦 陈依民 高峰 张京 张馨艺 何久盛 文良元[5] 王现海[6] 史宗新[7] 胡三保[8] 孙凤坡 龚子顺 孙明曜[8] 田懋一 朱仕文[1] 杨明辉[1] 吴新宝[1] Peng Weidong;Liu Gang;Ge Yufeng;Tan Zhelun;Chen Yimin;Gao Feng;Zhang Jing;Zhang Xinyi;He Jiusheng;Wen Liangyuan;Wang Xianhai;Shi Zongxin;Hu Sanbao;Sun Fengpo;Gong Zishun;Sun Mingyao;Tian Maoyi;Zhu Shiwen;Yang Minghui;Wu Xinbao(Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China;School of Population Health,University of New South Wales,Sydney 2052,Australia;The George Institute for Global Health at Peking University Health Science Centre,Beijing 100191,China;Department of Orthopaedics,Beijing Shunyi District Hospital,Beijing 101312,China;Department of Orthopedics,Beijing Hospital,Beijing 100730,China;Department of Orthopaedics,Beijing Changping District Hospital,Beijing 102202,China;Department of Orthopaedics,Beijing Fangshan District Liangxiang Hospital,Beijing 102401,China;Department of Orthopaedics,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;School of Public Health,Harbin Medical University,Harbin 150081,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035 [2]澳大利亚新南威尔士大学人群健康学院,悉尼2052 [3]北京大学医学部乔治全球健康研究院,北京100191 [4]北京市顺义区医院骨科,北京101312 [5]北京医院骨科,北京100730 [6]北京市昌平区医院骨科,北京102202 [7]北京市房山区良乡医院骨科,北京102401 [8]首都医科大学附属北京安贞医院骨科,北京100029 [9]哈尔滨医科大学公共卫生学院,哈尔滨150081

出　　处：《中华解剖与临床杂志》2023年第1期1-6,共6页Chinese Journal of Anatomy and Clinics

基　　金：首都卫生发展科研专项(首发2022-1-2071);北京积水潭医院高层次人才“学科骨干”培养计划(XKGG201807)。

摘　　要：目的评估北京地区老年髋部脆性骨折患者术后抗骨质疏松症药物(AOM)治疗现状并探讨其影响因素。方法横断面研究。纳入2018年11月—2019年11月北京积水潭医院、北京医院、北京安贞医院、北京市昌平区医院、北京市顺义区医院、北京市房山区良乡医院收治的髋部脆性骨折患者1963例,总结其人口学特征,并收集患者入院后30、120、365 d的临床资料,AOM治疗及健康基本补充剂使用情况。通过单因素和多因素logistic回归分析AOM治疗的影响因素。结果1963例老年髋部脆性骨折患者,住院时年龄65~102(79.3±7.2)岁,≥80岁患者占56.7%(1113/1963);男性患者占30.8%(604/1963),女性患者占69.2%(1359/1963);股骨颈骨折846例,股骨粗隆间骨折1077例,股骨粗隆下骨折40例。综合3个时间点,在髋部骨折后1年内,33.0%(648/1963)的患者接受过AOM治疗,71.0%(1394/1963)的患者使用过健康基本补充剂。入院后30、120、365 d患者AOM治疗率分别为23.0%(451/1963)、17.9%(353/1963)、21.0%(412/1963),健康基本补充剂使用率分别为59.0%(1158/1963)、45.0%(883/1963)、38.0%(746/1963)。单因素分析结果显示,年龄≥80岁[粗比值比(OR)=0.645,95%可信区间(CI)0.495~0.840]、男性(粗OR=0.760,95%CI 0.581~0.996)、共管模式(粗OR=3.025,95%CI 0.973~9.405)、居住地农村(粗OR=0.523,95%CI 0.388~0.704)、AOM服用史(粗OR=7.612,95%CI 2.227~26.020)、既往骨质疏松症史(粗OR=5.065,95%CI 3.149~8.147)、骨质疏松评估(粗OR=1.379,95%CI 1.105~2.451)是AOM治疗的影响因素。多因素分析结果显示,年龄≥80岁(调整后OR=0.618,95%CI 0.488~0.781)、男性(调整后OR=0.716,95%CI 0.565~0.908)、居住地农村(调整后OR=0.492,95%CI 0.375~0.645)是AOM治疗的危险因素;共管模式(调整后OR=2.632,95%CI 1.004~6.897)、AOM服用史(调整后OR=4.870,95%CI 2.080~11.402)、既往骨质疏松症史(调整后OR=4.804,95%CI 3.253~7.096)、骨质疏松评估(调整后OR=1.393,95%CI 1.041~1.862)是AOM治疗的保护�Objective A study was conducted to evaluate the current status and influencing factors of anti-osteoporosis medication(AOM)treatment after hip fragility fractures in elderly patients in Beijing,China.Methods A cross-sectional study was conducted.A total of 1963 patients with hip fragility fractures who were admitted to Beijing Jishuitan Hospital,Beijing Hospital,Beijing Anzhen Hospital,Beijing Changping District Hospital,Beijing Shunyi District Hospital,and Beijing Fangshan District Liangxiang Hospital from November 2018 to November 2019 were included.The demographic characteristics were summarized,and the clinical data,AOM treatment rates,and health basic supplements usage rates in 30,120,and 365 days after admission were collected.The influencing factors of AOM treatment were identified through univariate and multivariate logistic regression.Results Among 1963 elderly patients with hip fragility fractures,the age at hospitalization was 65-102(79.3±7.2)years old,and 56.7%(1113/1963)were≥80 years old.Among them,male patients accounted for 30.8%(604/1963),female patients accounted for 69.2%(1359/1963).There were 846 femoral neck fractures,1077 intertrochanteric fractures,and 40 subtrochanteric fractures.Combining the three time points,33.0%(648/1963)of the patients received AOM treatment after hip fracture within 1 year,and 71.0%(1394/1963)of the patients received health basic supplements after hip fracture within 1 year.At 30,120,and 365 days after admission,the AOM treatment rates were 23.0%(451/1963),17.9%(353/1963),and 21.0%(412/1963),and the use rates of health basic supplements were 59.0%(1158/1963),45.0%(883/1963),and 38.0%(746/1963),respectively.Univariate analysis showed that age≥80 years old(crude odds ratio[OR]=0.645,95%confidence interval[CI]0.495-0.840),male patients(crude OR=0.760,95%CI 0.581-0.996),co-management model(crude OR=3.025,95%CI 0.973-9.405),living in rural areas(crude OR=0.523,95%CI 0.388-0.704),previous AOM treatment(crude OR=7.612,95%CI 2.227-26.020),previous diagnosis of osteoporo

关 键 词：髋骨折 骨质疏松 抗骨质疏松症药物 老年人 双膦酸盐类 

分 类 号：R687.3[医药卫生—骨科学]