https://scholars.lib.ntu.edu.tw/handle/123456789/522938
標題: | Risk Factors for Poor Functional Recovery, Mortality, Recurrent Fractures, and Falls Among Patients Participating in a Fracture Liaison Service Program | 作者: | CHIA-TER CHAO RONG-SEN YANG Huang W.-J. KEH-SUNG TSAI DING-CHENG CHAN |
公開日期: | 2019 | 出版社: | Elsevier Inc. | 卷: | 20 | 期: | 9 | 起(迄)頁: | 1129-11400 | 來源出版物: | Journal of the American Medical Directors Association | 摘要: | Objective: A fracture liaison service (FLS) for patients with fractures is a promising approach for improving outcomes, but barriers to the successful implementation of an FLS remain. The factors influencing the outcomes of patients already receiving FLS care are unclear. Design: A prospective multicenter cohort study. Settings and participants: Patients with incident hip and clinical vertebral fractures treated at 2 institutions between January 2014 and June 2016 were prospectively enrolled. Demographic profiles, comorbidities, prior fracture experiences, T scores, Fracture Risk Assessment Tool (FRAX) scores, and serum markers were examined. Measures: Self-reported functional status (at the 4th month), mortality, recurrent fractures, and falls (at the 2-year follow-up). Results: Of 712 patients screened for eligibility, 600 (84%) participants (age 78 ± 10 years) were enrolled in the FLS program. At 4 months, 58%, 53%, and 60% of the participants reported improved mobility, self-care, and daily activities after FLS care, respectively. After 2 years, 85 (14%) died, 36 (6%) developed recurrent fractures, and 199 (33%) had 1 or more fall episodes. Multivariate logistic regression showed that neurologic disorders, heart disease, and diabetes were associated with a decreased probability of functional recovery. Cox regression showed that older age and chronic kidney disease (CKD) were predictive of increased mortality, whereas heart disease was correlated with an increased refracture risk. Older age and cancer or osteoarthritis were associated with a higher risk of falls. Importantly, a higher body mass index predicted a lower risk of mortality and a higher probability of improved self-care but a higher risk of fall at follow-up. Conclusions/Implications: We discovered that comorbidities including CKD, heart disease, cancer, and osteoarthritis could influence short-term functional changes, survival, and the risk of refractures or falls among patients participating in FLSs. These factors are expected to aid in prognosis estimation and management planning for those with fractures. ? 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060875532&doi=10.1016%2fj.jamda.2018.12.011&partnerID=40&md5=e402eb9fd8ebdf02c3eed35351359066 https://scholars.lib.ntu.edu.tw/handle/123456789/522938 |
ISSN: | 1525-8610 | DOI: | 10.1016/j.jamda.2018.12.011 | SDG/關鍵字: | albumin; alkaline phosphatase; calcium; creatinine; aged; albumin blood level; alcohol consumption; Article; body mass; bone density; chronic kidney failure; cohort analysis; comorbidity; controlled study; convalescence; creatinine blood level; daily life activity; diabetes mellitus; falling; female; follow up; fracture liaison service; fragility fracture; functional status; health service; heart disease; hip fracture; human; hypertension; major clinical study; male; malignant neoplasm; mortality; mortality risk; multicenter study; neurologic disease; osteoarthritis; osteoporosis; prospective study; risk factor; self care; spine fracture; very elderly; clinical trial; convalescence; falling; fragility fracture; physiology; recurrent disease; risk factor; self report; Accidental Falls; Aged; Aged, 80 and over; Body Mass Index; Female; Humans; Male; Osteoporotic Fractures; Outcome Assessment, Health Care; Prospective Studies; Recovery of Function; Recurrence; Renal Insufficiency, Chronic; Risk Factors; Self Report |
顯示於: | 醫學系 |
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