Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database.
Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database.
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DOI：
10.1136/rmdopen-2016-000249
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发表时间：
2016
期刊：
影响因子：
6.2
通讯作者：
Lafforgue P
中科院分区：
文献类型：
--
作者：
Trijau S;de Lamotte G;Pradel V;Natali F;Allaria-Lapierre V;Coudert H;Pham T;Sciortino V;Lafforgue P
长期糖皮质激素治疗是继发性骨质疏松症的主要原因。在许多欧洲国家，糖皮质激素诱导的骨质疏松症（GIOP）的管理似乎不足。目的：评价GIOP的检出率和治愈率。从2009年9月至2011年8月，从我们的地理区域Provence-Alpes-Côte-d‘Azur ’和科西嘉的国家公共医疗保险数据库收集了信息。我们确定了15岁及以上开始糖皮质激素治疗的参与者（至少连续90天，每天≥7.5 mg强的松当量）。该队列与年龄匹配和性别匹配的未接受糖皮质激素治疗的人群进行比较。骨量，骨抗吸收药物的处方和使用钙和/或维生素D治疗。我们确定了32812例接受糖皮质激素治疗的患者，患病率为1%。糖皮质激素治疗的发生率为2.8/1000居民/年。男性占44%，平均年龄58岁。中位泼尼松等效剂量为11 mg/天（IQR 9-18 mg/天）。8%接受了骨量测量。钙和/或维生素D和双膦酸盐分别占18%和12%。对照组的结果更低：3%的人接受了骨量测量，3%的人接受了双膦酸盐治疗。55岁以上女性的骨密度测量率和治疗率高于55岁及以下的男性和女性，而且当由风湿病学家开始糖皮质激素治疗时也高于其他专科医生。尽管有法定的健康保险制度，GIOP的管理仍然非常不足。需要有针对性的干预措施来改善GIOP的管理。
Long-term glucocorticoid therapy is the leading cause of secondary osteoporosis. The management of glucocorticoid-induced osteoporosis (GIOP) seems to be inadequate in many European countries. To evaluate the rate of screening and treatment of GIOP. Information was collected from a national public health-insurance database in our geographic area of Provence-Alpes-Côte-d'Azur and in Corsica, from September 2009 through August 2011. We identified participants aged 15 years and over starting glucocorticoid therapy (≥7.5 mg of prednisone equivalent per day during at least 90 days consecutive). This cohort was compared with an age-matched and sex-matched population that did not receive glucocorticoids. Bone mass, prescription of bone antiresorptive medication and use of calcium and/or vitamin D treatment. We identified 32 812 patients who were prescribed glucocorticoid therapy, yielding 1% prevalence. Incidence of glucocorticoid therapy was 2.8/1000 inhabitants/year. Males represented 44%, the mean age was 58 years. The median prednisone-equivalent dose was 11 mg/day (IQR 9–18 mg/day). 8% underwent bone mass measurement. Calcium and/or vitamin D, and bisphosphonates were prescribed in 18% and 12%, respectively. Results were lower for the control population: 3% underwent bone mass measurement and 3% received bisphosphonate therapy. The rates of osteodensitometry and treatments were higher in women over 55 years of age than in men and women 55 years of age and younger, and also when glucocorticoid therapy was initiated by a rheumatologist versus other physician specialty. The management of GIOP remains very inadequate, despite the availability of a statutory health insurance system. Targeted interventions are needed to improve the management of GIOP.