研究背景
髖部骨折是好發於高齡族群的骨折，死亡率高達20-24%，並經常伴隨獨立性和功能的喪失，造成患者的不良結果和家屬的負擔。而骨折聯合照護服務 (fracture liaison service, FLS) 為一次級預防模式，提升骨密度篩檢率、抗骨質疏鬆藥物 (anti-osteoporosis medication, AOM) 用藥率和依從性，並降低一年內的再骨折率與死亡率。先前研究亦證實能有效地改善術後的照護狀況，然而臺灣有關髖部骨折之骨折聯合照護服務正式發表的研究相對國外仍顯不足。

研究動機
臺灣的醫療機構中設有骨折聯合照護服務的院所僅占21%，許多醫院尚未加入其中，包含南部某醫學中心。在建立骨折聯合照護服務之前，需對一醫療院所的髖部骨折基線資料有全面的了解，透過髖部骨折後照護現況探討找出照護現況可能的問題。

研究目的
描述南部某醫學中心的中老年髖部骨折後個案之照護現況，並探討可能影響持續性照護現況中用藥依從性之相關因子。

研究方法
本研究為回溯性世代研究設計，使用國立成功大學醫學院附設醫院資料室之資料，資料期間為2019年1月份至2021年12月，納入條件為：(1) 年齡 ≥ 65歲；(2) 脆弱性髖部骨折並在成大醫院內有手術碼之個案資料。描述持續性照護現況，再透過抗骨質疏鬆藥物用藥依從性進行分組，分別為 AOM regular、AOM late、AOM one 和 AOM none，並以SPSS 26.0套裝軟體進行統計分析。

結果
2019年至2021年期間，共有839筆資料符合收案條件，AOM regular (n=176)、AOM late (n=42)、AOM one (n=53) 和 AOM none (n=568)。一年內 DXA 篩檢率 40.6%、一年內 AOM 率 32.3%，與有介入 FLS 的醫療院所相比尚有進步空間。而性別為女性且一年內有接受 DXA 篩檢者的一年內 AOM 治療率較高，且 AOM regular 組的一年內死亡率顯著低於 AOM none。

結論
本研究在未介入骨折聯合照護服務的情況下探討臺灣南部某醫學中心的髖部骨折持續性照護現況與其他未介入持續性照護的研究結果相比，照護現況略優，但與介入持續性照護的研究結果相比尚有進步空間。從用藥依從性的分組結果中可以發現，性別為男性且一年內未接受 DXA 篩檢者較容易有未持續用藥的狀況。且 AOM regular 組的一年內死亡率在本研究結果中顯著低於 AOM none，雖無法完全代表未持續用藥所帶來的影響，但優化持續性照護有其重要性。

SUMMARY
Hip fractures are common fractures in the older population, often leading to adverse outcomes for patients and a burden for their families. The aim of this study describe the current postoperative care status of old patients with hip fractures at a medical center in southern Taiwan and explore the associated factors that may influence anti-osteoporosis medication (AOM) adherence in ongoing care. This study employed a retrospective cohort design using the National Cheng Kung University Hospital database. The data spanned from January 2019 to December 2021. Between this period, a total of 839 cases met the inclusion criteria: AOM regular (n=176), AOM late (n=42), AOM one (n=53), and AOM none (n=568). The result is that the care status was found to be slightly better compared to other studies without intervention, and the grouping results based on medication adherence, it was observed that males who did not undergo DXA screening within one year were more likely to exhibit non-adherence. Additionally, the AOM regular group had significantly lower one-year mortality in this study's results compared to the AOM none group. But optimizing continuous care remains crucial.
Keywords: Fracture liaison service, hip fracture, medication adherence, older adults

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