骨质疏松性骨折后再骨折现状及管理策略的研究进展

Research advances on current situation and management strategies of re-fractures after osteoporotic fractures

骨质疏松症及其导致的骨质疏松性骨折发生率逐年增加,越来越多的学者关注到骨质疏松性骨折后2年内是再骨折的高风险时期,更是骨折二级预防的关键窗口期。骨质疏松性骨折是再骨折的重要危险因素,骨折后的时间间隔及骨折部位等诸多因素影响再骨折发生,因此传统的骨折风险评估工具并不适用于再骨折风险评估,新兴的再骨折风险评估工具已有初步报道。随着骨折联络服务(fracture liaison services,FLS)在全球范围内推广,综合管理策略在再骨折管理中行之有效,可提高骨质疏松性骨折患者的确诊率、治疗率和药物依从性,降低再骨折风险。但目前全球范围内存在多种不同模式的FLS项目,部分国家及地区的临床医生对骨质疏松性骨折后的管理缺陷存在认识不足、重视程度不够的问题,再骨折风险仍然迫在眉睫。通过系统性阐述骨质疏松性骨折后再骨折的最新现状、影响再骨折的危险因素及新兴的再骨折风险评估工具,从规范化抗骨质疏松症药物治疗、开展多学科协助的FLS以及重视早期、个性化的康复治疗三个方面梳理再骨折的防治管理策略,以期为我国骨质疏松性骨折后管理提供参考和借鉴。

The incidence of osteoporosis and its resulting osteoporotic fractures is increasing year by year.More and more scholars pay attention to the fact that the 2 years after osteoporotic fractures is a high-risk period for re-fractures and the key window period for secondary fracture prevention.Osteoporotic fractures are important risk factors for re-fractures,and many other factors,such as the time interval after fracture and fracture site,affect the occurrence of re-fractures.Therefore,traditional fracture risk assessment tools are not suitable for the re-fracture risk assessment,while preliminary reports of emerging re-fracture risk assessment tools have been available.In recent years,with the worldwide promotion of fracture liaison service(FLS),the comprehensive management strategies have effectively improved the diagnosis rate,treatment rate and drug compliance of patients with osteoporotic fractures,while reducing the risk of re-fractures.However,there are a variety of FLS projects with different models around the world,clinicians in some countries and regions have insufficient understanding and attention to the absence of management after osteoporotic fractures,and the risk of re-fractures is still imminent.Therefore,this article systematically elaborated the latest status of re-fractures after osteoporotic fractures,risk factors affecting re-fractures and new re-fracture risk assessment tools.The prevention and management strategies of re-fractures are summarized from three aspects:the standardized anti-osteoporosis drug therapy,the multidisciplinary FLS,as well as the early and personalized rehabilitation therapy,in order to provide references for clinical management of osteoporotic fractures in China.