Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis.

IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Osteoporosis International Pub Date : 2024-09-01 Epub Date: 2024-05-14 DOI:10.1007/s00198-024-07078-5
Anum Ali, Ella Huszti, Shahryar Noordin, Usman Ali, Joanna E M Sale
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Abstract

Purpose: This systematic review seeks to evaluate the proportion of fragility fracture patients screened in secondary fracture prevention programs who were indicated for pharmacological treatment, received prescriptions for bone-active medications, and initiated the prescribed medication. Additionally, the study aims to analyze equity in pharmacological treatment by examining equity-related variables including age, sex, gender, race, education, income, and geographic location.

Methods: We conducted a systematic review to ascertain the proportion of fragility fracture patients indicated for treatment who received prescriptions and/or initiated bone-active medication through secondary fracture prevention programs. We also examined treatment indications reported in studies and eligibility criteria to confirm patients who were eligible for treatment. To compute the pooled proportions for medication prescription and initiation, we carried out a single group proportional meta-analysis. We also extracted the proportions of patients who received a prescription and/or began treatment based on age, sex, race, education, socioeconomic status, location, and chronic conditions.

Results: This review included 122 studies covering 114 programs. The pooled prescription rate was 77%, and the estimated medication initiation rate was 71%. Subgroup analysis revealed no significant difference in treatment initiation between the Fracture Liaison Service and other programs. Across all studies, age, sex, and socioeconomic status were the only equity variables reported in relation to treatment outcomes.

Conclusion: Our systematic review emphasizes the need for standardized reporting guidelines in post-fracture interventions. Moreover, considering equity stratifiers in the analysis of health outcomes will help address inequities and improve the overall quality and reach of secondary fracture prevention programs.

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研究骨折二级预防中骨活性药物使用的治疗目标和公平性:系统综述和荟萃分析。
目的:本系统性综述旨在评估在骨折二级预防计划中接受筛查的脆性骨折患者中,有药物治疗指征、收到骨活性药物处方并开始服用处方药物的患者比例。此外,本研究还旨在通过考察年龄、性别、种族、教育程度、收入和地理位置等与公平相关的变量,分析药物治疗的公平性:我们进行了一项系统性回顾,以确定有治疗指征的脆性骨折患者中通过骨折二级预防计划获得处方和/或开始服用骨活性药物的比例。我们还检查了研究报告中的治疗适应症和资格标准,以确认符合治疗条件的患者。为了计算药物处方和用药的汇总比例,我们进行了单组比例荟萃分析。我们还根据年龄、性别、种族、教育程度、社会经济地位、地点和慢性病状况,提取了获得处方和/或开始治疗的患者比例:本综述包括 122 项研究,涉及 114 个项目。汇总处方率为 77%,估计开始用药率为 71%。分组分析表明,骨折联络服务与其他项目在开始治疗方面没有明显差异。在所有研究中,年龄、性别和社会经济地位是唯一与治疗结果相关的公平变量:我们的系统性综述强调了在骨折后干预中制定标准化报告指南的必要性。此外,在分析健康结果时考虑公平分层因素将有助于解决不公平问题,并提高二次骨折预防计划的整体质量和覆盖范围。
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来源期刊
Osteoporosis International
Osteoporosis International 医学-内分泌学与代谢
CiteScore
8.10
自引率
10.00%
发文量
224
审稿时长
3 months
期刊介绍: An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.
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