ABSTRACT
BACKGROUND: Hip fractures are the most serious fragility fractures due to their associated disability, higher hospitalization costs and high mortality rates. Fracture Liaison Service (FLS) programs have enhanced the management of osteoporosis-related fractures and have shown their clinical effectiveness. AIMS: To analyze the effect of the implementation of a FLS model of care over the survival and mortality rates following a hip fracture. METHODS: We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture before and after the implementation of the FLS in our center (between January 2016 and December 2019). Patients were followed for three years after the index date. Mortality, complications and refracture rates were compared between the two groups using a Multivariate Cox proportional hazard model. RESULTS: A total of 1366 patients were included in this study (353 before FLS implementation and 1013 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (79.3% vs 12.5%; p < 0.01) and there was an increase in adherence to treatment (51.7% vs 30.2%; p < 0.01). A total of 413 (40.8%) patients after FLS implementation and 141 (39.9%) individuals before (p = 0.47) died during the three-years follow-up period. A second fracture occurred in 101 (10.0%) patients after FLS implementation and 37 (10.5%) individuals before (p = 0.78). Patients after the implementation of the FLS protocol had a lower all cause one-year mortality [adjusted Hazard Ratio (HR) 0.74 (0.57-0.94)] and a decreased risk of suffering a second osteoporotic fracture [adjusted HR 0.54 (0.39-0.75) in males and adjusted HR 0.46 (0.30-0.71) in females]. CONCLUSIONS: The implementation of a FLS protocol was associated with a lower all-cause one-year mortality rate and a higher survivorship in elderly hip fracture patients. However, no three-year mortality rate differences were observed between the two groups. We also found a reduction in the complication and second-fracture rates.
Subject(s)
Hip Fractures , Osteoporosis , Osteoporotic Fractures , Secondary Prevention , Humans , Hip Fractures/mortality , Female , Male , Aged , Aged, 80 and over , Osteoporotic Fractures/prevention & control , Osteoporotic Fractures/mortality , Secondary Prevention/methods , Prospective Studies , Middle Aged , Proportional Hazards Models , Bone Density Conservation Agents/therapeutic useABSTRACT
Esta investigación tuvo como objetivo conocer los principales factores de riesgo asociados a la mortalidad por neumonía en la población menor de un año de Santa Fe de Bogotá, para generar conocimiento que permita reorientar las acciones de prevención adelantadas por el programa de prevención y control de las enfermedades diarreicas e infecciones respiratorias agudas, CED-IRA. Es un estudio de casos y controles pareado 1:2, retrospectivo. Los datos se tomaron en menores de un año que enfermaron o murieron por neumonía en el segundo semestre de 1996 o primer semestre de 1997, identificados con los certificados de defunción. Para los controles se utilizaron usuarios de los servicios de hospitalización.
The objective of this study was to determine the main risk factors associated with mortality due to pneumonia in the population under one year of age in Santa Fe de Bogotá, in order to generate knowledge to reorient prevention actions carried out by the program for the prevention and control of diarrheal diseases and acute respiratory infections, CED-IRA. This is a 1:2, retrospective, matched case-control study. Data were collected in children under one year of age who became ill or died from pneumonia in the second semester of 1996 or first semester of 1997, identified by death certificates. Users of hospitalization services were used for controls.
Subject(s)
Humans , Male , Female , Infant, Newborn , Risk Factors , Infant Mortality , Pneumonia , Respiratory Tract Infections , Case-Control Studies , Disease , MortalityABSTRACT
La mortalidad por neumonía es uno de los principales problemas de salud pública de la población menor de un año de Santafé de Bogotá; conocer el comportamiento de esta enfermedad respiratoria brinda herramientas para orientar la intervención frente a este problema y reducir las tasas de mortalidad a través de acciones integrales. Este libro permite conocer los principales factores de riesgo asociados a la mortalidad por neumonía, mediante la descripción teórica de los factores de riesgo asociados a la misma en diferentes lugares del mundo; además, aporta información para que los planificadores y ejecutores de programas y proyectos de salud infantil cuenten con elementos para desarrollar programas y medidas de prevención y control de las enfermedades respiratorias. Así mismo, plantea la necesidad de ahondar en algunos aspectos relacionados con el acceso a los servicios de salud y pone énfasis en la necesidad de continuar la vigilancia epidemiológica de este evento, a partir del análisis individual de los casos de mortalidad por neumonía
