Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women
Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women
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DOI：
10.1007/s00198-007-0506-x
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发表时间：
2008-06-01
影响因子：
4
通讯作者：
Reginster, J. -Y.
中科院分区：
文献类型：
--
作者：
Rabenda, V.;Mertens, R.;Reginster, J. -Y.
依从性现在是骨质疏松症管理中的主要问题之一，几篇论文表明，不适当遵循处方的患者可能会增加椎体骨折。本文涉及到坚持抗骨质疏松治疗和随后的hipfracture.Introduction的风险之间存在的密切关系进行了研究，以调查坚持双磷酸盐（BP）治疗和坚持对髋部骨折（Fx）的风险的影响。方法比利时国家社会保障数据库进行了详尽的搜索。入组研究的患者为绝经后女性，未接受过BP治疗，接受了阿仑膦酸钠的首次处方。使用药物拥有率（MPR）量化12个月时的依从性。持续性计算为从初始处方到完成前一次补充后超过5周的间隔的天数。使用逻辑回归模型估计依从性对髋部骨折风险的影响。使用考克斯比例风险模型分析了持续性对髋部骨折风险的影响。结果与每日阿仑膦酸钠治疗的患者（n = 14，136）相比，每周接受阿仑膦酸钠治疗的患者（n = 15.021）在12个月时的平均MPR显著更高（每日= 58.6%;每周= 70.5%; p < 0.001）。12个月时，持续率为39.45%。MPR每降低1%，髋关节Fx风险增加0.4%（OR：0.996; CI 95%：0.994-0.998; p < 0.001）。髋关节Fx的相对风险降低为60%（HR：0.404; CI 95%：0.357-0.457; p < 0.0001）的持续性相比，非持续性patients.Conclusion这些结果证实，坚持目前的治疗方案仍然是次优的。
Adherence is now one of the major issues in the management of osteoporosis and several papers have suggested that vertebral fractures might be increased in patients who do not follow appropriately their prescriptions. This paper relates the strong relationship existing between adherence to anti-osteoporosis treatment and the risk of subsequent hip fracture.Introduction A study was performed to investigate adherence to bisphosphonate (BP) therapy and the impact of adherence on the risk of hip fracture (Fx).Methods An exhaustive search of the Belgian national social security database was conducted. Patients enrolled in the study were postmenopausal women, naive to BP, who received a first prescription of alendronate. Compliance at 12 months was quantified using the medication possession ratio (MPR). Persistence was calculated as the number of days from the initial prescription to a gap of more than 5 weeks after completion of the previous refill. A logistic regression model was used to estimate the impact of compliance on the risk of hip fracture. The impact of persistence on hip fracture risk was analysed using the Cox proportional hazards model.Results The mean MPR at 12 months was significantly higher among patients receiving weekly (n = 15.021) compared to daily alendronate (n = 14,136) (daily = 58.6%; weekly = 70.5%; p < 0.001). At 12 months, the rate of persistence was 39.45%. For each decrease of the MPR by 1%, the risk of hip Fx increased by 0.4% (OR: 0.996; CI 95%: 0.994-0.998; p < 0.001). The relative risk reduction for hip Fx was 60% (HR: 0.404; CI 95%: 0.357-0.457; p < 0.0001) for persistent compared to non-persistent patients.Conclusion These results confirm that adherence to current therapeutic regimens remains suboptimal.