亞太地區骨折聯合照護服務現況及未來

Fracture Liaison Services for Osteoporosis in the Asia-Pacific Region: Now and the Future

張尹凡(Yin-Fan Chang) ； 詹鼎正(Ding-Cheng Chan) ； 張若愚(Lo-Yu Chang) ； 陳崇桓(Chung-Hwan Chen) ； 陳榮福(Jung-Fu Chen) ； 黃國恩(Ko-En Huang) ； 高義然(I-Jan Gau) ； 蔡克嵩(Keh-Sung Tsai) ； 林高田(Gau-Tyan Lin) ； 楊榮森(Rong-Sen Yang) ； 吳至行(Chih-Hsing Wu)

《台灣醫學》 22卷2期 (2018/03) Pp. 147-151

https://doi.org/10.6320/FJM.201803_22(2).0005

摘要

骨質疏鬆症是骨量流失及骨頭強度減少導致骨折風險升高之疾病，並且會增加相關疾病之罹病率及死亡率。骨鬆性骨折未來幾十年在亞太地區將急遽增加。預估至2050年時一半髖骨骨折會發生在亞洲，同時骨鬆性骨折相關花費及失能損失預期在亞洲地區亦將急遽上升。骨折聯合照護服務(fracture liaison services，FLS)在之前研究顯示可增加骨折病人接受骨密度檢查、藥物治療之比率、及改善遵醫囑性，明顯可減少骨折病人再骨折風險及死亡率。因此國際骨鬆基金會( International Osteoporosis Foundation，IOF)在2012年起建議各國建立骨折聯合照護服務系統以完整照護骨折病人，雖然骨折聯合照護服務在亞太地區正快速建立，但各醫療院所、甚至各國家間對於骨鬆性骨折之醫療照護仍有明顯差異。因此IOF所建立的13項準則基本上均可應用於亞太地區建立骨折聯合照護服務時運用，只需要在一些項目做因地制宜的修正。未來在越來越多骨折聯合照護服務建立後，期待有更多臨床經驗及資料可回饋再修正13項準則。

關鍵字

骨折 ； 亞太地區 ； 聯合照護服務

並列摘要

Osteoporosis is characterized by a reduction in bone mass with a subsequent loss in strength that increases bone fragility and raises the risk of fracture, and is associated with high morbidity and increased mortality. During the next few decades, osteoporotic fractures are predicted to increase dramatically in the Asia-Pacific region. By 2050, it is projected that up to half of all hip fractures will occur in Asia. Moreover, the costs and disability associated with osteoporosis-related fractures are high and expected to dramatically increase in Asia. Fracture liaison services (FLS) interventions led to substantial increases in rates of bone mineral density testing and osteoporosis treatment, improved therapy adherence, and resulted in significant reduction in re-fracture and mortality rates. Therefore, the International Osteoporosis Foundation recommends the establishment of FLS to properly identify and treat fracture patients since 2012. However, there is still significant care gap for fragility fractures even with rapid growing of FLSs in the AP region. After careful review and through discussion, experts agreed that the 13 best practice framework����BPF����standards are generally applicable in the AP region with only minor modifications. More clinical experiences and more data are needed to provide feedback for ongoing improvement on BPF standards and to benchmark the best FLSs in the future.

並列關鍵字

fracture ； Asia-Pacific ； fracture liaison services

參考文獻

Curtis E, Moon R, Dennison E, et al: Recent advances in the pathogenesis and treatment of osteoporosis. Clinical Medicine (London) 2016;16:360-4.

Kanis JA: Assessment of osteoporosis at the primary health care level. UK: University of Sheffield, 2007.

IOF: The Asia-Pacific Regional Audit: Epidemiology, costs & burden of osteoporosis, 2013.

Gullberg B, Johnell O, Kanis JA: World-wide projections for hip fracture. Osteoporos Int 1997;7:407-13.

IOF: The Asian Audit: Epidemiology, costs, and burden of osteoporosis in Asia, 2009.