防範第二次骨折的全方位策略

Comprehensive Strategies for Prevention of the Second Fracture

骨質疏鬆症病患經常發生脆弱性骨折，這些骨折病患再度發生骨折的風險比一般人增高兩倍，且半數病患在日後會發生第二次骨折，即一個骨折會導致第二個骨折；所幸相對於整體族群而言，這些高骨折風險的病患人數只佔小部分，善加照顧的醫療費用低於一級骨折預防，效果卻十分顯著；針對這些高骨折風險的族群，建置一項病患篩選和照護的全方位體系，在他們發生第一個骨折時及早診治，可望有效降低未來骨折率達20-25%，且可撙節龐大經費。2011 年，國際骨質疏鬆基金會學術委員會骨折工作小組呼籲，建置一個以協調員為基礎的骨折照護系統，預防脆弱性骨折患者發生第二次骨折，目前全世界的許多成功策略，都是採用以協調員為基礎的作業方式，協調員乃是骨科治療小組、骨質疏鬆症和跌倒治療小組、病患和第一線醫師之間的聯絡橋樑。這些處置方式已獲證實具有良好成本效益。一旦達成此先期目標後，再循序漸進推廣到中度骨折風險和低骨折風險的病患族群骨骼保健和骨折預防。臺灣的脆弱性骨折很常見，髖部骨折發生率高居全世界的前十名；所幸臺灣的健保制度涵蓋99%以上的全國人民納保；且越來越多病患關心骨骼健康，在此呼籲大家建立此種全方位模式，結合各層面的資訊，提供病患篩選和照護的策略，以落實預防第二次骨折的目標。

Fragility fractures are common in patients who have osteoporosis. It is estimated that a prior fracture at any skeletal site will double of future fracture risk. Almost half of them will sustain a second fracture in their life, i.e., fracture begets fracture. Fortunately the number of these patients with high fracture risk is small as compared with population, comprehensive care of them may achieve good outcome with relatively lower medical cost as compared with primary fracture prevention. Thus we need to establish a comprehensive system of case finding and care for these patients with high fracture risk when they had first fracture. Such a system with post-fracture osteoporosis treatment of fracture patients can reduce the overall incidence of hip fractures by 20-25% and enormous cost savings. In 2011, the Fracture Working Group of the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) recommended coordinator-based systems for secondary prevention in patients with fragility fractures. Currently many successful systems for secondary fracture prevention worldwide employed a coordinator-incorporated practical strategy. The coordinator can efficiently link the practice among the orthopaedic team, the osteoporosis and falls services, the patient and the primary care physician. Such a strategy has been proved highly cost-effective. Once the goal is achieved, it can be followed by stepwise implementation of bone health and fracture prevention programs in those with moderate and low fracture risk. The fragility fracture is common in Taiwan, with hip fracture incidence ranked top 10 in the world. Fortunately the National Health Insurance system in Taiwan covered almost 99% population and more and more people in Taiwan are concerned about the issue of bone health. Therefore, we earnestly request to establish such a comprehensive care system to become a platform for information from all levels, to provide implementation strategies for case selection and care as well to achieve the final goal for capture the fracture.