Papaioannou Alexandra, Ioannidis George, Adachi Jonathan D, Sebaldt Rolf J, Ferko Nicole, Puglia Mark, Brown Jacques, Tenenhouse Alan, Olszynski Wojciech P, Boulos Pauline, Hanley David A, Josse Robert, Murray Timothy M, Petrie Annie, Goldsmith Charlie H
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Osteoporos Int. 2003 Oct;14(10):808-13. doi: 10.1007/s00198-003-1431-2. Epub 2003 Sep 11.
Therapies for osteoporosis must be taken for at least 1 year to be effective. The purpose of this study was to determine the difference in adherence to etidronate, alendronate and hormone replacement therapy in a group of patients seen at our tertiary care centres. The Canadian Database of Osteoporosis and Osteopenia (CANDOO), a prospective observational database designed to capture clinical data, was searched for patients who started therapy following entry into CANDOO. There were 1196 initiating etidronate, 477 alendronate and 294 hormone replacement therapy women and men aged (mean, SD) 65.8 (8.7) years in the study. A Cox proportional hazards regression model was used to assess differences between treatment groups in the time to discontinuation of therapy. Several potential covariates such as anthropometry, medications, illnesses, fractures and lifestyle factors were entered into the model. A forward selection technique was used to generate the final model. Hazard ratios and 95% confidence intervals (CI) were calculated. Adjusted results indicated that alendronate-treated patients were more likely to discontinue therapy as compared with etidronate-treated patients (1.404; 95% CI: 1.150, 1.714). After 1 year, 90.3% of patients were still taking etidronate compared with 77.6% for alendronate. No statistically significant differences were found between hormone replacement therapy and etidronate users (0.971; 95% CI: 0.862, 1.093) and hormone replacement therapy and alendronate users (0.824; 95% CI: 0.624, 1.088) after controlling for potential covariates. After 1 year, 80.1% of patients were still taking hormone replacement therapy, which decreased to 44.5% after 6 years. Increasing age and presence of incident non-vertebral fractures were found to be independent predictors of adherence. In conclusion, alendronate users were more likely to discontinue therapy than etidronate users over the follow-up period. Potential barriers to long-term patient adherence to osteoporosis therapies need to be evaluated.
骨质疏松症的治疗必须持续至少1年才会有效。本研究的目的是确定在我们三级医疗中心就诊的一组患者中，依替膦酸盐、阿仑膦酸盐和激素替代疗法在依从性方面的差异。我们在加拿大骨质疏松症和骨质减少症数据库（CANDOO）中进行搜索，该数据库是一个前瞻性观察数据库，旨在收集临床数据，以查找在进入CANDOO后开始治疗的患者。本研究中有1196名开始使用依替膦酸盐治疗的患者、477名开始使用阿仑膦酸盐治疗的患者以及294名开始使用激素替代疗法的患者，这些患者的年龄（均值，标准差）为65.8（8.7）岁，包括男性和女性。使用Cox比例风险回归模型来评估各治疗组在治疗中断时间上的差异。将一些潜在的协变量，如人体测量学指标、药物、疾病、骨折和生活方式因素等纳入该模型。采用向前选择技术生成最终模型。计算风险比和95%置信区间（CI）。调整后的结果表明，与接受依替膦酸盐治疗的患者相比，接受阿仑膦酸盐治疗的患者更有可能中断治疗（风险比为1.404；95% CI：1.150，1.714）。1年后，90.3%的患者仍在服用依替膦酸盐，而服用阿仑膦酸盐的患者这一比例为77.6%。在控制潜在协变量后，未发现激素替代疗法使用者与依替膦酸盐使用者之间存在统计学显著差异（风险比为0.971；95% CI：0.862，1.093），以及激素替代疗法使用者与阿仑膦酸盐使用者之间存在统计学显著差异（风险比为0.824；95% CI：0.624，1.088）。1年后，80.1%的患者仍在服用激素替代疗法，6年后这一比例降至44.5%。研究发现年龄增加和发生非椎体骨折是依从性的独立预测因素。总之，在随访期间，阿仑膦酸盐使用者比依替膦酸盐使用者更有可能中断治疗。需要评估患者长期坚持骨质疏松症治疗的潜在障碍。
