脆弱性骨折的负担超过了许多其他慢性疾病
一项新的研究对欧洲五个最大的国家(法国、德国、意大利、西班牙和英国)以及瑞典因骨质疏松引起的脆弱性骨折的负担和治疗进行了综述和比较。《欧洲脆弱性骨折：负担、管理和机遇》一书由国际骨质疏松基金会(IOF)指导委员会与各国协会的专家合作撰写。
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.
骨质疏松症是一种慢性疾病，在这种情况下，骨量和强度降低，导致骨折风险增加。脆弱性骨折是老年人致残和早期死亡的一个主要原因，50岁及以上的老年人中，三分之一的女性和五分之一的男性在其余生中都承受着骨折的痛苦。。
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.
作者发现，2017年，这六个国家估计有270万例脆弱性骨折，导致相关的年度成本为375亿欧元。到2030年，年度脆弱性断裂的数量预计将增加23%，达到330万，预计成本约为474亿欧元。
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.
脆弱性骨折的负担超过了许多其他慢性疾病。2017年，由于骨折，估计损失了102万质量调整寿命年(QALYS)。目前每1000名50岁或50岁以上的人的残疾调整后生命年估计为21年，高于对中风或慢性阻塞性肺疾病的估计。骨折还导致生产力下降，这六个国家的非退休人员在2017年共请病假760万天。
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损伤，包括疼痛、行动不便和害怕摔倒，甚至会使诸如穿衣和洗衣服等简单的日常活动变得困难。因此，家庭成员等非正式照顾者的负担可能很大。在西班牙和意大利，髋部骨折后亲属的平均年护理时间分别高达每1000人每年744小时和652小时。脆弱性骨折造成的另一个主要和昂贵的负担是对独立性的长期影响，这可能需要个人搬进长期护理(LTC)设施。进入LTC的患者比例从50-60岁的2.1%到90岁及以上的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对患者、其家庭和国家医疗体系造成的沉重负担外，该研究还根据未接受药物治疗的合格人员的百分比，确定了所有国家的巨大治疗缺口。在英国，治疗差距最小(女性为64%，男性为43%)，德国为最高，只有20%的合格男性和22%的女性接受药物治疗以预防未来的骨折。
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.
鉴于第一次骨折是未来骨折的警告信号，骨折后治疗骨质疏松症至关重要，也是防止骨折复发、疼痛和长期残疾的关键。然而，骨折患者开始治疗的比例很低。在法国、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疗。
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.
专家们已经表明，骨折后护理模式，如骨折联络服务(FLSs)，是一种具有成本效益的护理模式，有可能增加接受治疗的高危患者的数量，提高对治疗的依从性，降低再骨折的风险。然而，六个欧洲国家的骨折联络服务覆盖率都不理想。作者估计，如果FLS能进一步扩大到六个国家的所有骨折患者，每年将避免19262例额外骨折，骨折相关费用每年将减少2.855亿欧元。
