Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

被引:189
作者
Harvey, N. C. W. [1 ,2 ,3 ]
McCloskey, E. V. [4 ,5 ]
Mitchell, P. J. [6 ,7 ]
Dawson-Hughes, B. [8 ]
Pierroz, D. D. [9 ]
Reginster, J. -Y. [10 ]
Rizzoli, R. [11 ,12 ]
Cooper, C. [1 ,13 ]
Kanis, J. A. [14 ,15 ]
机构
[1] Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England
[2] Univ Southampton, NIHR Southampton Biomed Res Ctr, Southampton, Hants, England
[3] Univ Hosp Southampton NHS Fdn Trust, Southampton, Hants, England
[4] Northern Gen Hosp, MRC ARUK Ctr Integrated Res Musculoskeletal Agein, Metab Bone Ctr, Sheffield, S Yorkshire, England
[5] Univ Sheffield, Mellanby Ctr Bone Res, Sheffield, S Yorkshire, England
[6] Synth Med NZ Ltd, Auckland, New Zealand
[7] Univ Notre Dame Australia, Sydney, NSW, Australia
[8] Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
[9] IOF, Nyon, Switzerland
[10] Univ Liege, Dept Publ Hlth Epidemiol & Hlth Econ, Liege, Belgium
[11] Geneva Univ Hosp, Div Bone Dis, Geneva, Switzerland
[12] Fac Med, Geneva, Switzerland
[13] Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, NIHR Musculoskeletal Biomed Res Unit, Oxford, England
[14] Univ Sheffield, Ctr Metab Bone Dis, Med Sch, Sheffield, S Yorkshire, England
[15] Catholic Univ Australia, Inst Hlth & Aging, Melbourne, Vic, Australia
关键词
Case Finding; Disease Awareness; Fragility Fracture; Osteoporosis; Policy; Primary Prevention; Prioritisation; Secondary Prevention; BONE-MINERAL DENSITY; GLUCOCORTICOID-INDUCED OSTEOPOROSIS; INFLAMMATORY-BOWEL-DISEASE; VERTEBRAL FRACTURE; POSTMENOPAUSAL WOMEN; HIP FRACTURE; STRONTIUM RANELATE; PRACTICE FRAMEWORK; LIAISON SERVICE; CANCER-PATIENTS;
D O I
10.1007/s00198-016-3894-y
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into four distinct themes: (1) case finding and management of individuals at high risk of fracture, (2) public awareness of osteoporosis and fragility fractures, (3) reimbursement and health system policy and (4) epidemiology of fracture in the developing world. Findings from cohort studies, randomised controlled trials, systematic reviews and meta-analyses, in addition to current clinical guidelines, position papers and national and international audits, are summarised, with the intention of providing a prioritised approach to delivery of optimal bone health for all. Systematic approaches to case-finding individuals who are at high risk of sustaining fragility fractures are described. These include strategies and models of care intended to improve case finding for individuals who have sustained fragility fractures, those undergoing treatment with medicines which have an adverse effect on bone health and people who have diseases, whereby bone loss and, consequently, fragility fractures are a common comorbidity. Approaches to deliver primary fracture prevention in a clinically effective and cost-effective manner are also explored. Public awareness of osteoporosis is low worldwide. If older people are to be more pro-active in the management of their bone health, that needs to change. Effective disease awareness campaigns have been implemented in some countries but need to be undertaken in many more. A major need exists to improve awareness of the risk that osteoporosis poses to individuals who have initiated treatment, with the intention of improving adherence in the long term. A multisector effort is also required to support patients and their clinicians to have meaningful discussions concerning the risk-benefit ratio of osteoporosis treatment. With regard to prioritisation of fragility fracture prevention in national policy, there is much to be done. In the developing world, robust epidemiological estimates of fracture incidence are required to inform policy development. As the aging of the baby boomer generation is upon us, this review provides a comprehensive analysis of how bone health can be improved worldwide for all.
引用
收藏
页码:1507 / 1529
页数:23
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