脆弱性骨折的負(fù)擔(dān)超過(guò)了許多其他慢性疾病

A new study provides an overview and comparison of the burden and management of fragility fractures due to osteoporosis in the five largest countries in Europe (France, Germany, Italy, Spain, and the United Kingdom) as well as Sweden. The publication 'Fragility fractures in Europe: burden, management and opportunities' has been authored by an International Osteoporosis Foundation (IOF) steering committee in cooperation with experts from national societies.

一項(xiàng)新的研究對(duì)歐洲五個(gè)最大的國(guó)家(法國(guó)、德國(guó)、意大利、西班牙和英國(guó))以及瑞典因骨質(zhì)疏松引起的脆弱性骨折的負(fù)擔(dān)和治療進(jìn)行了綜述和比較?！稓W洲脆弱性骨折：負(fù)擔(dān)、管理和機(jī)遇》一書(shū)由國(guó)際骨質(zhì)疏松基金會(huì)(IOF)指導(dǎo)委員會(huì)與各國(guó)協(xié)會(huì)的專(zhuān)家合作撰寫(xiě)。

Osteoporosis is a chronic condition in which bone mass and strength decrease causing an increased risk of fractures. Fragility fractures are a major cause of disability and early death in older adults, with one in three women and one in five men aged fifty and above sustaining a fracture in their remaining lifetime.

骨質(zhì)疏松癥是一種慢性疾病，在這種情況下，骨量和強(qiáng)度降低，導(dǎo)致骨折風(fēng)險(xiǎn)增加。脆弱性骨折是老年人致殘和早期死亡的一個(gè)主要原因，50歲及以上的老年人中，三分之一的女性和五分之一的男性在其余生中都承受著骨折的痛苦。。

The authors find that in 2017 an estimated 2.7 million fragility fractures in the six countries resulted in an associated annual cost of €37.5 billion. By 2030, the number of annual fragility fractures is expected to increase by 23 per cent, to 3.3 million, with projected costs of approximately €47.4 billion.

作者發(fā)現(xiàn)，2017年，這六個(gè)國(guó)家估計(jì)有270萬(wàn)例脆弱性骨折，導(dǎo)致相關(guān)的年度成本為375億歐元。到2030年，年度脆弱性斷裂的數(shù)量預(yù)計(jì)將增加23%，達(dá)到330萬(wàn)，預(yù)計(jì)成本約為474億歐元。

The burden of fragility fractures exceeds those of many other chronic diseases. An estimated 1.02 million quality-adjusted life years (QALYSs) were lost in 2017 due to fracture. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more is estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. Fractures also result in loss of productivity, with sick days taken in 2017 by non-retired individuals in the six countries totaling 7.6 million days.

脆弱性骨折的負(fù)擔(dān)超過(guò)了許多其他慢性疾病。2017年，由于骨折，估計(jì)損失了102萬(wàn)質(zhì)量調(diào)整壽命年(QALYS)。目前每1000名50歲或50歲以上的人的殘疾調(diào)整后生命年估計(jì)為21年，高于對(duì)中風(fēng)或慢性阻塞性肺疾病的估計(jì)。骨折還導(dǎo)致生產(chǎn)力下降，這六個(gè)國(guó)家的非退休人員在2017年共請(qǐng)病假760萬(wàn)天。

Impairment due to fragility fractures, which includes pain, immobility and fear of falling, can make even simple daily activities such as dressing and washing difficult. As a result, the burden on informal caregivers such as family members may be significant. Average annual hours of care by relatives after a hip fracture is found to be as high 744 hours and 652 hours, per year, per 1000 individuals, in Spain and Italy respectively. Another major and costly burden caused by fragility fractures is the long-term impact on independence which may require individuals to move into long-term care (LTC) facilities. The percentage of patients moving into LTC varies from 2.1% at ages 50-60 years to 35.3% at ages 90 and above.

由于脆弱性骨折造成的損傷，包括疼痛、行動(dòng)不便和害怕摔倒，甚至?xí)怪T如穿衣和洗衣服等簡(jiǎn)單的日常活動(dòng)變得困難。因此，家庭成員等非正式照顧者的負(fù)擔(dān)可能很大。在西班牙和意大利，髖部骨折后親屬的平均年護(hù)理時(shí)間分別高達(dá)每1000人每年744小時(shí)和652小時(shí)。脆弱性骨折造成的另一個(gè)主要和昂貴的負(fù)擔(dān)是對(duì)獨(dú)立性的長(zhǎng)期影響，這可能需要個(gè)人搬進(jìn)長(zhǎng)期護(hù)理(LTC)設(shè)施。進(jìn)入LTC的患者比例從50-60歲的2.1%到90歲及以上的35.3%不等。

As well as quantifying the heavy burden of fragility fractures on patients, their families, and national healthcare systems, the study also identifies a massive treatment gap in all countries, based on the percentage of eligible individuals not receiving medication. The smallest treatment gap is in the UK (64% in women and 43% in men) and the highest treatment gap in Germany, with only 20% of eligible men and 22% of women receiving a pharmacological intervention to prevent future fractures.

除了量化脆弱性骨折對(duì)患者、其家庭和國(guó)家醫(yī)療體系造成的沉重負(fù)擔(dān)外，該研究還根據(jù)未接受藥物治療的合格人員的百分比，確定了所有國(guó)家的巨大治療缺口。在英國(guó)，治療差距最小(女性為64%，男性為43%)，德國(guó)為最高，只有20%的合格男性和22%的女性接受藥物治療以預(yù)防未來(lái)的骨折。

Given that a first fracture is a warning sign of future fractures, post-fracture care to treat osteoporosis is of critical importance and the key to preventing a cycle of recurring fractures, pain and long-term disability. Nevertheless, the proportion of fracture patients starting treatment is low. In France, Sweden and Spain, 85%, 84% and 72% of fracture patients remained untreated one year after fracture.

鑒于第一次骨折是未來(lái)骨折的警告信號(hào)，骨折后治療骨質(zhì)疏松癥至關(guān)重要，也是防止骨折復(fù)發(fā)、疼痛和長(zhǎng)期殘疾的關(guān)鍵。然而，骨折患者開(kāi)始治療的比例很低。在法國(guó)、瑞典和西班牙，85%、84%和72%的骨折患者在骨折一年后仍未得到治療。

Experts have shown that post-fracture care models such as Fracture Liaison Services (FLSs) are cost-effective care delivery models which have the potential to increase the number of high-risk patients being treated, improve adherence to treatment and reduce the risk of re-fracture. However, FLS coverage is suboptimal in the six European countries. The authors estimate that if FLS could be further expanded to reach all fracture patients in the six countries, 19,262 additional fractures every year would be avoided, and fracture-related costs would be reduced by €285.5 million annually.

專(zhuān)家們已經(jīng)表明，骨折后護(hù)理模式，如骨折聯(lián)絡(luò)服務(wù)(FLSs)，是一種具有成本效益的護(hù)理模式，有可能增加接受治療的高危患者的數(shù)量，提高對(duì)治療的依從性，降低再骨折的風(fēng)險(xiǎn)。然而，六個(gè)歐洲國(guó)家的骨折聯(lián)絡(luò)服務(wù)覆蓋率都不理想。作者估計(jì)，如果FLS能進(jìn)一步擴(kuò)大到六個(gè)國(guó)家的所有骨折患者，每年將避免19262例額外骨折，骨折相關(guān)費(fèi)用每年將減少2.855億歐元。