脆弱性骨折的負擔超過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.

一項新的研究對歐洲五個最大的國家(法國、德國、意大利、西班牙和英國)以及瑞典因骨質(zhì)疏松引起的脆弱性骨折的負擔和治療進行了綜述和比較?！稓W洲脆弱性骨折：負擔、管理和機遇》一書由國際骨質(zhì)疏松基金會(IOF)指導委員會與各國協(xié)會的專家合作撰寫。

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，骨量和強度降低，導致骨折風險增加。脆弱性骨折是老年人致殘和早期死亡的一個主要原因，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，這六個國家估計有270萬例脆弱性骨折，導致相關的年度成本為375億歐元。到2030年，年度脆弱性斷裂的數(shù)量預計將增加23%，達到330萬，預計成本約為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.

脆弱性骨折的負擔超過了許多其他慢性疾病。2017年，由于骨折，估計損失了102萬質(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)整后生命年估計為21年，高于對中風或慢性阻塞性肺疾病的估計。骨折還導致生產(chǎn)力下降，這六個國家的非退休人員在2017年共請病假760萬天。

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、行動不便和害怕摔倒，甚至會使諸如穿衣和洗衣服等簡單的日?；顒幼兊美щy。因此，家庭成員等非正式照顧者的負擔可能很大。在西班牙和意大利，髖部骨折后親屬的平均年護理時間分別高達每1000人每年744小時和652小時。脆弱性骨折造成的另一個主要和昂貴的負擔是對獨立性的長期影響，這可能需要個人搬進長期護理(LTC)設施。進入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患者、其家庭和國家醫(yī)療體系造成的沉重負擔外，該研究還根據(jù)未接受藥物治療的合格人員的百分比，確定了所有國家的巨大治療缺口。在英國，治療差距最小(女性為64%，男性為43%)，德國為最高，只有20%的合格男性和22%的女性接受藥物治療以預防未來的骨折。

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骨折的警告信號，骨折后治療骨質(zhì)疏松癥至關重要，也是防止骨折復發(fā)、疼痛和長期殘疾的關鍵。然而，骨折患者開始治療的比例很低。在法國、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.

專家們已經(jīng)表明，骨折后護理模式，如骨折聯(lián)絡服務(FLSs)，是一種具有成本效益的護理模式，有可能增加接受治療的高?；颊叩臄?shù)量，提高對治療的依從性，降低再骨折的風險。然而，六個歐洲國家的骨折聯(lián)絡服務覆蓋率都不理想。作者估計，如果FLS能進一步擴大到六個國家的所有骨折患者，每年將避免19262例額外骨折，骨折相關費用每年將減少2.855億歐元。