Benefit of adherence with bisphosphonates depends on age and fracture type: Results from an analysis of 101,038 new bisphosphonate users
Benefit of adherence with bisphosphonates depends on age and fracture type: Results from an analysis of 101,038 new bisphosphonate users
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DOI：
10.1359/jbmr.080418
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发表时间：
2008-09-01
影响因子：
6.2
通讯作者：
Delzell, Elizabeth
中科院分区：
文献类型：
--
作者：
Curtis, Jeffrey R.;Westfall, Andrew O.;Delzell, Elizabeth
在不同年龄的成年人中，口服双磷酸盐的高依从性与不同类型骨折风险之间的关系尚未得到充分研究。利用美国一家大型医疗保健组织的索赔数据，我们使用药物持有率 (MPR) 量化了开始双膦酸盐治疗后的依从性，并确定了骨折情况。使用 Cox 比例风险模型来评估不同年龄层和各种临床骨折类型中不依从者 (MPR < 50%) 与高度依从者 (MPR >= 80%) 的骨折率。结合非依从性骨折发生率，这些估计值用于计算按年龄和骨折类型进行高依从性治疗以预防骨折所需的人数。在 101,038 名双膦酸盐新使用者中，1 年、2 年和 3 年依从性较高的比例分别为 44%、39% 和 35%。在医生诊断为骨质疏松症的 65 至 78 岁人群中，非依从性髋部骨折的粗略和调整后发生率分别为 1.96（95% CI，1.48-2.60）和 1.74（95% CI，1.30-2.31），导致需要高依从性治疗以防止 1 例髋部骨折的人数为 107。高依从性的影响要小得多适用于其他类型的骨折和年轻人。以非时间依赖性方式对依从性进行分析，人为地放大了依从性和非依从性人群之间骨折率的差异。与口服双磷酸盐的高依从性相关的抗骨折效果因年龄和骨折类型而有很大差异。这些结果提供了跨年龄亚组和骨折类型的绝对骨折有效性估计，这些结果在临床试验中进行了最低程度的评估，可能对未来的成本效益研究有用。
The relationship between high adherence to oral bisphosphonates and the risk of different types of fractures has not been well studied among adults of different ages. Using claims data from a large U.S. health care organization, we quantified adherence after initiating bisphosphonate therapy using the medication possession ratio (MPR) and identified fractures. Cox proportional hazards models were used to evaluate the rate of fracture among nonadherent persons (MPR < 50%) compared with highly adherent persons (MPR >= 80%) across several age strata and a variety of types of clinical fractures. In conjunction with fracture incidence rates among the nonadherent, these estimates were used to compute the number needed to treat with high adherence to prevent one fracture, by age and fracture type. Among 101,038 new bisphosphonate users, the proportion of persons with high adherence at 1, 2, and 3 yr was 44%, 39%, and 35%, respectively. Among 65- to 78-yr-old persons with a physician diagnosis of osteoporosis, the crude and adjusted rate of hip fracture among the nonadherent was 1.96 (95% CI, 1.48-2.60) and 1.74 (95% CI, 1.30-2.31), respectively, resulting in a number needed to treat with high adherence to prevent one hip fracture of 107. The impact of high adherence was substantially less for other types of fractures and for younger persons. Analysis of adherence in a non-time-dependent fashion artifractually magnified differences in fracture rates between adherent and nonadherent persons. The antifracture effectiveness associated with high adherence to oral bisphosphonates varied substantially by age and fracture type. These results provide estimates of absolute fracture effectiveness across age subgroups and fracture types that have been minimally evaluated in clinical trials and may be useful for future cost-effectiveness studies.