Siris Ethel S, Harris Steven T, Rosen Clifford J, Barr Charles E, Arvesen James N, Abbott Thomas A, Silverman Stuart
Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, Harkness Pavilion 9-964, 180 Fort Washington Ave, New York, NY 10032, USA.
Mayo Clin Proc. 2006 Aug;81(8):1013-22. doi: 10.4065/81.8.1013.
To characterize the relationships between adherence (complance and persistence) to bisphosphonate therapy and risk of specific fracture types in postmenopausal women.
Data were collected from 45 employers and 100 health plans in the continental United States from 2 claims databases during a 5-year period (January 1, 1999, through December 31, 2003). Claims from patients receiving a bisphosphonate prescription (alendronate or risedronate) were evaluated for 6 months before the Index prescription and during 24 months of follow-up to determine total, vertebral, and nonvertebral osteoporotic fractures, persistence (no gap in refills for >30 days during 24 months), and refill compliance (medication possession ratio > or = 0.80).
The eligible cohort included 35,537 women (age, > or = 45 years) who received a bisphosphonate prescription. A subgroup with a specified diagnosis of postmenopausal osteoporosis was also evaluated. Forty-three percent were refill compliant, and 20% persisted with bisphosphonate therapy during the 24-month study period. Total, vertebral, nonvertebral, and hip fractures were significantly lower in refill-compliant and persistent patients, with relative risk reductions of 20% to 45%. The relationship between adherence and fracture risk remained significant after adjustment for baseline age, concomitant medications, and fracture history. There was a progressive relationship between refill compliance and fracture risk reduction, commencing at refill compliance rates of approximately 50% and becoming more pronounced at compliance rates of 75% and higher.
Adherence to bisphosphonate therapy was associated with significantly fewer fractures at 24 months. Increasing refill compliance levels were associated with progressively lower fracture rates. These findings suggest that incremental changes in medication-taking habits could improve clinical outcomes of osteoporosis treatment.
明确绝经后女性双膦酸盐治疗的依从性（顺应性和持续性）与特定骨折类型风险之间的关系。
在5年期间（1999年1月1日至2003年12月31日），从美国大陆的45家雇主和100个健康计划的2个理赔数据库中收集数据。对接受双膦酸盐处方（阿仑膦酸钠或利塞膦酸钠）的患者在索引处方前6个月及随访的24个月期间的理赔情况进行评估，以确定总的、椎体和非椎体骨质疏松性骨折、持续性（24个月内再填充无超过30天的间断）以及再填充顺应性（药物持有率≥0.80）。
符合条件的队列包括35537名接受双膦酸盐处方的女性（年龄≥45岁）。还对有绝经后骨质疏松特定诊断的亚组进行了评估。43%的患者再填充顺应性良好，20%的患者在24个月的研究期间持续接受双膦酸盐治疗。再填充顺应性良好和持续治疗的患者总的、椎体、非椎体和髋部骨折明显较少，相对风险降低20%至45%。在对基线年龄、伴随用药和骨折史进行调整后依从性与骨折风险之间的关系仍然显著。再填充顺应性与骨折风险降低之间存在渐进关系，从大约50%的再填充顺应率开始，在75%及更高的顺应率时变得更加明显。
坚持双膦酸盐治疗在24个月时骨折明显减少。再填充顺应性水平的提高与骨折率逐渐降低相关。这些发现表明服药习惯的渐进性改变可改善骨质疏松治疗的临床结局。
