Summary

This study was carried out to describe the profile of prescription of antiosteoporotic treatment at discharge after a hip fracture in the Spanish National Hip Fracture Registry. Prescription rates among hospitals ranged from 0 to 94% of patients discharged. The prescription rate was higher among patients with better cognitive and functional baseline status.

Purpose

National hip fracture registries are useful for assessing current care processes. The goals of this study were as follows: first, to know the rate of antiosteoporotic prescription at discharge among hip fracture patients in hospitals participating in the Spanish National Hip Fracture Registry (RNFC); second, to compare the differences between treated and non-treated patients; third, to analyze patients’ characteristics associated with antiosteoporotic prescription at discharge; and fourth, to evaluate whether there were differences in the profile of patients discharged from hospitals with high and low prescription rates.

Method

Patients discharged after a fragility hip fracture in 2017 and participating in the RNFC were included. Demographic variables, cognitive and functional status, prefracture osteoporosis treatment, fracture type, anesthetic risk, hospital volume, and antiosteoporotic prescription at discharge were analyzed. Given that patients were clustered within hospitals, intraclass correlation was calculated and generalized estimating equations were fitted.

Results

A total of 6701 patients from 54 hospitals were included. Antiosteoporotic prescription at discharge was prescribed to 36.5% (CI95% 35.8–37.2%), with a wide inter-hospital variability (range 0–94%). The intraclass correlation due of clustering of patients within hospitals was 47.9%. Antiosteoporotic prescription was more likely in patients who were younger, lived at home, previously treated for osteoporosis, had better baseline functional and cognitive status, lower anesthetic risk, and were discharged from high-volume hospitals, all with p < 0.001. The general profile of patients discharged from hospitals with high and low rate of prescription was similar.

Conclusions

There is a wide variability between hospitals regarding antiosteoporotic prescription after hip fracture. This is more likely to be initiated in patients with better clinical, functional, and mental status and in those discharged from hospitals with larger volumes of patients. These results offer insights regarding the selection of patients receiving secondary prevention and raises questions on who and how many should be treated.

中文翻译：

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国家髋部骨折登记处对评估出院后接受抗骨质疏松治疗的患者概况的有用性。

概括

本研究旨在描述西班牙国家髋部骨折登记处髋部骨折后出院时抗骨质疏松治疗处方的概况。医院的处方率范围为出院患者的 0% 至 94%。认知和功能基线状态较好的患者的处方率较高。

目的

国家髋部骨折登记处可用于评估当前的护理过程。本研究的目标如下：首先，了解参与西班牙国家髋部骨折登记处（RNFC）的医院中髋部骨折患者出院时的抗骨质疏松处方率；第二，比较治疗和未治疗患者的差异；第三，分析出院时与抗骨质疏松处方相关的患者特征；第四，评估出院患者的高低处方率是否存在差异。

方法

包括 2017 年脆性髋部骨折后出院并参加 RNFC 的患者。分析人口统计学变量、认知和功能状态、骨折前骨质疏松症治疗、骨折类型、麻醉风险、住院容量和出院时的抗骨质疏松症处方。鉴于患者聚集在医院内，计算组内相关性并拟合广义估计方程。

结果

共纳入来自 54 家医院的 6701 名患者。出院时的抗骨质疏松处方为 36.5%（CI95% 35.8-37.2%），医院间差异很大（范围 0-94%）。医院内患者聚集的组内相关性为 47.9%。抗骨质疏松症处方更有可能出现在年轻、居家、先前接受过骨质疏松症治疗、基线功能和认知状态较好、麻醉风险较低以及从高容量医院出院的患者中，所有这些患者的p  < 0.001。处方率高和低的医院出院患者的总体情况相似。

结论

不同医院在髋部骨折后的抗骨质疏松处方方面存在很大差异。这更有可能在临床、功能和精神状态较好的患者以及从患者数量较多的医院出院的患者中开始。这些结果提供了有关选择接受二级预防的患者的见解，并提出了应该治疗谁和多少人的问题。