PDF(Pubmed)
Abstract：
To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50 years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1 year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2 years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2 years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO-CRD42021266408.
摘要：
确定并评估骨折联络服务（FLS）在降低50岁以上老年人继发性脆性骨折风险方面的确定性，并检查FLS的性质以及涉及FLS交付的各个学科的作用。Medline,EMBASE,PubMed,CINAHL,Scopus,从1月1日开始搜索Cochrane图书馆,2010年至5月31日,2022年。两个审阅者独立地提取数据。偏倚的风险评估使用纽卡斯尔-渥太华量表进行队列研究，PEDro量表进行随机试验，而等级方法确立了证据的确定性。确定了37项研究，其中34项（91.9％）被认为具有低偏倚风险，22项（59.5％）进行了荟萃分析。临床重要的1年低确定性证据（RR0.26，CI0.13至0.52，6项汇总研究）和≥2年中度确定性证据（RR0.68，CI0.55至0.83，13项汇总研究）表明，与非FLS干预相比，FLS干预中继发性脆性骨折的风险较低。没有观察到异质性的敏感性分析证实了这些发现。这篇综述发现了临床上重要的中度确定性证据，表明在≥2年的FLS干预中，继发性脆性骨折的风险较低。在这一领域进行更多高质量的研究可以提高证据的确定性。审查注册：PROSPERO-CRD42021266408。
