Long‐term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence
Long‐term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence
复制标题
坚持口服双膦酸盐对骨质疏松性骨折发生率的长期影响
DOI：
10.1002/jbmr.533
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发表时间：
2012
影响因子：
6.2
通讯作者：
C. Kindundu
中科院分区：
文献类型：
--
作者：
J. Sampalis;J. Adachi;E. Rampakakis;J. Vaillancourt;A. Karellis;C. Kindundu
对骨质疏松症治疗的依从性是导致真实的生活实践中效果欠佳的关键参数。尚未评估依从性对骨折风险的长期影响。这是一项回顾性研究，使用省级健康保险索赔数据库，评估1996年4月至2009年12月期间所有安大略骨质疏松症患者口服双膦酸盐（OBP）依从性与骨质疏松性骨折发生率之间的相关性。采用多变量logistic回归模型评估OBP依从性与骨折风险之间的关系。治疗持续时间分为2年间隔。依从性通过药物拥有率（MPR）进行评估，持续性定义为连续治疗的时间长度，无间隔补充>30天。研究队列由636，114例患者组成，其中36.1%的患者接受0 - 2年的OBP处方，19.7%的患者接受2 - 4年的OBP处方，15.1%的患者接受4 - 6年的OBP处方，12%的患者接受6 - 8年的OBP处方，9.1%的患者接受8 - 10年的OBP处方，6.1%的患者接受10 - 12年的OBP处方，1.9%的患者接受12 - 14年的OBP处方。总体而言，队列的平均（SD）依从性为0.72（0.30），53.5%的患者依从性>80%，24.6%的患者在14年随访期间持续接受治疗。在整个14年期间观察到高依从性和骨折风险降低之间的显著相关性;分类依从性的总体比值比MPR >80%或MPR ≤80%者，持续依从性和持续性分别为0.909（95%置信区间[CI] 0.893-0.925）、0.918（95% CI 0.893-0.944）和0.804（95% CI 0.787-0.821）。总之，在真实的生活环境中，坚持OBP治疗骨质疏松症是次优的。依从性差与骨质疏松性骨折风险增加之间存在显著正相关，且随治疗时间延长而增加。© 2012美国骨与矿物质研究学会
Adherence to osteoporosis treatments is a critical parameter resulting in suboptimal effectiveness in real‐life practice. The long‐term effect of adherence on fracture risk has not been assessed. This was a retrospective study using provincial health insurance claims databases to assess the association between adherence to oral bisphosphonates (OBP) and incidence of osteoporotic fractures in all Ontario patients with osteoporosis between April 1996 and December 2009. Multivariate logistic regression models were used to assess the association between OBP adherence and fracture risk. Treatment duration was classified into 2‐year intervals. Compliance was estimated with the medication possession ratio (MPR), and persistence was defined as the length of continuous therapy without a gap in refills >30 days. The study cohort was composed of 636,114 patients, among whom 36.1% were prescribed OBPs for 0 to 2 years, 19.7% for 2 to 4 years, 15.1% for 4 to 6 years, 12% for 6 to 8 years, 9.1% for 8 to 10 years, 6.1% for 10to 12 years, and 1.9% for 12 to 14 years. Overall, the mean (SD) compliance for the cohort was 0.72 (0.30) with 53.5% of the patients having compliance >80% and 24.6% being persistent with treatment during the 14‐year follow‐up period. Significant associations between high adherence and reduced fracture risk over the entire 14‐year period were observed; the overall odds ratio for categorical compliance (MPR >80% or MPR ≤80%), continuous compliance, and persistence were 0.909 (95% confidence interval [CI] 0.893–0.925), 0.918 (95% CI 0.893–0.944), and 0.804 (95% CI 0.787–0.821), respectively. In conclusion, adherence to OBP in osteoporosis management is suboptimal in a real‐life setting. A significant positive association exists between poor adherence and increased risk of osteoporotic fractures, which becomes augmented with longer treatment duration. © 2012 American Society for Bone and Mineral Research