Parikh Seema, Mogun Helen, Avorn Jerry, Solomon Daniel H
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Womens' Hospital, Harvard Medical School, Boston, MA 02120, USA.
Arch Intern Med. 2008 May 26;168(10):1111-5. doi: 10.1001/archinte.168.10.1111.
Little is known about osteoporosis medication use among high-risk patients in nursing homes (NHs). We studied the patterns and predictors of osteoporosis medication use in elderly patients who sustained a fracture and were admitted to an NH.
We linked pharmaceutical claims data from 2 state-run drug assistance programs for elderly patients to Medicare data for the years 1995 through 2004. We defined the rates of osteoporosis medication use among patients admitted to an NH following a hip, wrist, or humeral fracture for the 12-month period after the fracture. Predictors of using an osteoporosis medication were assessed in a multivariate Cox proportional hazards model adjusting for age and sex.
Of the 4430 eligible postfracture patients, only 11.5% were prescribed an osteoporosis medication. There was a progressive increase in use from 1.6% in 1995 to 18.7% in 2001 but no increases in 2001 through 2004. Patient characteristics associated with osteoporosis medication use included a history of osteoporosis medication use in the prior 12 months (hazard ratio, 19.5; 95% confidence interval, 16.0-23.7) and female sex (hazard ratio, 1.57; 95% confidence interval, 1.13-2.21). A history of falls or fracture was not a significant factor. Calcitonin was the most commonly used osteoporosis medication (56%).
While the rate of osteoporosis medication use increased across the 10-year period, a low rate of osteoporosis medication use persists in the NH setting. More appropriate use of drug treatment of high-risk patients is needed in NHs.
对于疗养院（NHs）中高危患者使用骨质疏松症药物的情况知之甚少。我们研究了发生骨折并入住NHs的老年患者使用骨质疏松症药物的模式及预测因素。
我们将来自两个针对老年患者的国营药物援助项目的药品报销数据与1995年至2004年的医疗保险数据相链接。我们定义了髋部、腕部或肱骨骨折后入住NHs的患者在骨折后12个月内使用骨质疏松症药物的比例。在多变量Cox比例风险模型中，对年龄和性别进行调整后，评估使用骨质疏松症药物的预测因素。
在4430名符合条件的骨折后患者中，只有11.5%的患者被开具了骨质疏松症药物。使用比例从1995年的1.6%逐步上升至2001年的18.7%，但在2001年至2004年期间没有增加。与使用骨质疏松症药物相关的患者特征包括在过去12个月内有使用骨质疏松症药物的病史（风险比，19.5；95%置信区间，16.0 - 23.7）以及女性（风险比，1.57；95%置信区间，1.13 - 2.21）。跌倒或骨折史不是一个显著因素。降钙素是最常用的骨质疏松症药物（56%）。
虽然在这10年期间骨质疏松症药物的使用比例有所增加，但在NHs环境中，骨质疏松症药物的使用率仍然较低。NHs需要更合理地对高危患者使用药物治疗。
