Post-graduate theses
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| Identifier |
000463766 |
| Title |
Πρωτόκολλο αντιοστεοπορωτικής αγωγής σε ασθενείς με κατάγματα ευθραυστότητας : εφαρμογή και αποτελεσματικότητα |
| Alternative Title |
Osteoporosis treatment protocol in patients with fragility fractures |
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Author
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Δασκαλάκης, Ιωάννης Ι.
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Thesis advisor
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Τοσουνίδης, Θεόδωρος
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Reviewer
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Κοντάκης, Γεώργιος
Καραντάνας, Απόστολος
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| Abstract |
Background: Osteoporosis and fragility fractures are a major health care worldwide, with 9 million fractures occurring per year. Occurrence one fragility fracture is the most significant predictor of secondary fracture incidence. Without appropriate anti-osteoporotic medication, there is an 85% increased risk of secondary fracture incidence. Hip fractures have the most significant impact on patients, as they require surgical treatment and a large percentage of patients never recover their pre-facture mobility status. Furthermore, hip fracture patients have a significantly increased risk of suffering a second hip fracture within the next few years. Consequently, secondary fracture prevention with prescription of appropriate anti-osteoporotic medication is an essential part of hip fracture treatment. Despite this fact, osteoporosis treatment rates remain significantly low. With the purpose of improving secondary fracture prevention, two models of care have been described, the fracture liaison service and orthogeriatric care programs. Both models are effective, however their implementation is limited by economic factors of health-care systems. For that reason, the Arbeitsgemeinschaft für Osteosynthesefragen (AO) implemented a secondary fracture prevention algorithm, specifically designed to be utilized by orthopedic surgeons.The aim of this study is to report the outcomes of the in-hospital application of the AO foundation surgeon-led anti-osteoporotic medication algorithm to patients with hip fractures.
Aim: The aim of this study is prescription of anti-osteoporotic medication to patients hospitalized due to hip fracture using the AO foundation algorithm and determines persistence to medication and investigate secondary fracture incidence in persistent vs non-persistent patients. Materials and methods: This prospective cohort study followed patients with hip fractures who were treated at the Department of Orthopaedic Surgery of the University Hospital of Heraklion, that is a tertiary referral hospital, during the time period between 2020 and 2022. At discharge, anti-osteoporotic medication according to the AO Foundation algorithm was prescribed to all patients. Persistence to medication and secondary fracture incidence were recorded. Multivariate Cox regression analysis was used to investigate the risks of non-persistence to medication and of secondary fracture.
Results: Two hundred thirteen consecutive patients were included in this study and prospectively followed. Mean follow-up was 17.2 ±7.1 months. Persistence to medication at 2 years was 58% (95%CI 51 – 65%), of the highest in the contemporary literature. Secondary facture incidence was significantly lower in the persistent group, as secondary osteoporotic fracture occurred in 1/126 (0.8%) persistent patients and 9/87 (11.4%) non-persistent patients. Multivariable Cox regression analysis confirmed that non-persistence to medication was significantly associated with a lower risk of secondary fracture (cause-specific hazard ratio [csHR] 0.05; 95%CI 0.01 – 0.45; p = 0.007) Mortality was lower in the persistent group, however the difference was not statistically significant. (cause-specific HR 0.52; 95% CI 0.16-1.71; p= 0.281).
Conclusion: The application of the surgeon-led AO Foundation algorithm enables the in-hospital initiation of anti-osteoporotic treatment, leading to better persistence to medication and decreased incidence of secondary osteoporotic fractures. Therefore, the AO Foundation algorithm is a useful tool for secondary fracture prevention.
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| Language |
Greek, English |
| Subject |
Antiosteoporotic medication |
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Hip fracture |
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Secondary fracture |
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Δευτερογενής πρόληψη καταγμάτων |
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Κάταγμα ισχίου |
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Κάταγμα χαμηλής βίας |
| Issue date |
2024-04-17 |
| Collection
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School/Department--School of Medicine--Department of Medicine--Post-graduate theses
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Type of Work--Post-graduate theses
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| Permanent Link |
https://elocus.lib.uoc.gr//dlib/b/5/8/metadata-dlib-1712725291-470694-12497.tkl
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| Views |
5 |
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