老年骨鬆性骨折患者之臨床照護

Orthogeriatric Care and Treatment of Fragility Fractures in the Elderly

10.29461/TGG.201205.0003

吳凱文(Karl Wu)；張至宏(Chih-Hung Chang)；楊榮森(Rong-Sen Yang)

骨鬆骨折 ； 臨床治療 ； 骨質疏鬆症 ； fragility fracture ； clinical treatment ； osteoporosis

台灣老年醫學暨老年學雜誌

7卷2期（2012 / 05 / 01）

91 - 104

繁體中文

骨質疏鬆症是多因素造成之骨骼疾病，特色是骨量減少，結構破壞，因而導致骨骼脆弱和骨折風險增加。每位髖部骨折的骨鬆患者，未來再發生骨折的危險較一般人高達三倍；同時在骨折的後一年內，患者的死亡率高達15～30%。骨質疏鬆症是造成老年患者失能和死亡的一大原因。骨質疏鬆症的危險因子包括，年紀、性別、種族、生活型態和本身疾病。跌倒是個未被重視的危險因子，但卻是造成多種骨折的主因。蛋白質、鈣質和維生素D補充品能增加骨密度和減少跌倒。老年醫學醫師在面對此類患者時，除骨折治療之外，應積極介入骨質疏鬆症之防治，評估骨折和骨質疏鬆症危險因子，並予以治療。對於正在住院的患者，應為其擬定骨質疏鬆症追蹤和治療計畫；對於門診患者，應在適當評估後，開始投予適合患者的抗骨質疏鬆症藥物治療。當評估適當的狀況下，投予抗骨鬆藥物可降低續發低能量骨折的風險。預防跌倒、適度運動和平衡訓練有助改善生活不便和增加存活時間。評估和治療造成次發性骨質疏鬆症的原因也是相當重要。本文針對骨鬆性骨折治療作一系列完整回顧；依循這些治療準則，早期發現骨折風險，適當預防和治療，可望減低骨鬆患者發生骨折的風險。

Osteoporosis is a skeletal disease characterized by reduction in bone mass and deterioration of the architecture of bone tissue, resulting in increased risk of bone fragility and fracture. Elderly patients with a history of previous hip fracture are at 3-fold risk of future fragility fractures; moreover, the first year mortality rate is approximately 15~30% after hip fractures. Osteoporosis is one of the major causes of disability, morbidity and mortality in elderly patients. There are numerous risk factors, including age, gender, race, lifestyle, and concomitant medical conditions. Fall is a previously underestimated risk factor, responsible for a large percentage of fractures. Adequate supplement of protein, calcium and vitamin D can increase bone mineral density and decrease the risk of fall. Besides treating fractures, geriatricians should initiate proper treatment for osteoporosis, evaluate future fracture risk, and manage risk factors for osteoporosis. Doctors should make a tailored plan to treat osteoporosis for hospitalized patients as well as start osteoporotic medications for patients after proper clinical evaluation. Administrating anti-osteoporotic medications can reduce future risk of low-impact hip fractures. Fall prevention, proper exercise, and balance training are essential to prevent functional disability and improve survival. Evaluation and management of secondary causes of osteoporosis and concomitant medical conditions are also very important. In this article, we perform a comprehensive review of the osteoporotic treatment strategies. According to related treatment guidelines, early identification of those at higher fracture risk and timely preventive or therapeutic intervention may help decrease the risk of osteoporotic fractures.

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