The association between compliance and persistence with bisphosphonate therapy and fracture risk: A review
The association between compliance and persistence with bisphosphonate therapy and fracture risk: A review
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DOI：
10.1186/1471-2474-8-97
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发表时间：
2007-09-26
影响因子：
2.3
通讯作者：
Cowell, Warren
中科院分区：
文献类型：
--
作者：
Adachi, Jonathan;Lynch, Niall;Cowell, Warren
背景资料：次优水平的依从性和持久性与双膦酸盐有可能损害减少绝经后骨质疏松（PMO）fracture risk.Methods：进行结构化文献检索（1990-2006），以确定主要的研究评估依从性和持久性与双膦酸盐和绝经后骨质疏松（PMO）骨折风险在临床实践中的关系。检索标准为：二膦酸盐;绝经后妇女骨质疏松/骨质减少;所有类型的骨折;依从性和持久性。结果：只有两项使用处方数据库的回顾性研究专门评估了双膦酸盐。一项追踪35，537名女性的队列研究报告称，在24个月内药物持有率（MPR）>= 80%的患者中，骨折风险低于MPR < 80%的患者（8.5% vs 10.7%，p < 0.001，相对风险降低（RRR）21%）。在坚持治疗的女性中（再充盈间隙< 30天），骨折的风险也较低（7.7% vs10.3%，p < 0.001，RRR 29%）。一项巢式病例对照研究报告称，持续服用12个月（续药间隙<先前处方（Rx）时间的50%）与骨折风险降低26%相关（p < 0.05），持续服用24个月与骨折风险降低32%相关（p < 0.05）。另外4项非双膦酸盐研究报告，依从性≥ 12个月可降低骨折风险约25%。结论：依从性和持续性不佳的双膦酸盐并不能提供最佳的预防PMO骨折的风险，但在临床实践中需要更多的研究来阐明这种关系。
Background: Sub optimal levels of compliance and persistence with bisphosphonates are potentially compromising the reduction of post menopausal osteoporotic (PMO) fracture risk.Methods: A structured literature search (1990-2006) was performed to identify primary research studies evaluating the relationship between compliance and persistence with bisphosphonates and post menopausal osteoporotic ( PMO) fracture risk in clinical practice. Search criteria were: bisphosphonates; osteoporosis/osteopenia in postmenopausal women; all types of fractures; compliance and persistence.Results: Only two retrospective studies using prescription databases have specifically evaluated bisphosphonates. A cohort study tracking 35,537 women reported that in those with a Medication Possession Ratio (MPR) of >= 80% over 24 months the risk of fracture was lower than in those with an MPR of < 80% (8.5% v 10.7%, p < 0.001, Relative Risk Reduction (RRR) 21%). In women who persisted with treatment (refill gap < 30 days) the risk of fracture was also lower (7.7% v 10.3%, p < 0.001, RRR 29%). A nested case control study reported that 12 months persistence ( refill gap < 50% previous prescription (Rx) length) was associated with a 26% reduced risk of fracture ( p < 0.05) and 24 months with a 32% reduced risk (p < 0.05). Four other studies, not specific to bisphosphonates, reported that compliance >= 12 months decreased fracture risk by similar to 25%.Conclusion: Sub optimal compliance and persistence with bisphosphonates is not providing the best possible protection against the risk of PMO fracture, however, more research is needed to delineate this relationship in clinical practice.