骨质疏松症治疗依从性对北美和欧洲骨折率的影响。

Impact of osteoporosis treatment adherence on fracture rates in North America and Europe.

作者信息

Siris Ethel S, Selby Peter L, Saag Kenneth G, Borgström Fredrik, Herings Ron M C, Silverman Stuart L

机构信息

Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA.

出版信息

Am J Med. 2009 Feb;122(2 Suppl):S3-13. doi: 10.1016/j.amjmed.2008.12.002.

DOI:10.1016/j.amjmed.2008.12.002

PMID:19187810

Abstract

Fragility fractures associated with osteoporosis constitute a significant public health concern. Clinical trials have shown that a variety of agents--bisphosphonates, raloxifene, calcitonin, hormone replacement therapy, teriparatide, and strontium ranelate--can reduce the risk of osteoporosis-related fragility fractures. However, low levels of compliance and persistence in the real-life setting mean that efficacy benefits observed in clinical trials with these agents may not translate into equivalent effectiveness in daily practice. The aim of this review is to provide a comprehensive evaluation of compliance and persistence data from retrospective/observational studies, with particular reference to studies that consider the effects on fracture rates. PubMed of the National Center for Biotechnology Information (NCBI) and Web of Science databases were searched for publications detailing observational or retrospective analyses of adherence, compliance, and persistence with osteoporosis therapies. In addition, authors provided relevant studies that were not retrieved using the search criteria. In total, 17 unique publications were identified. Analysis of the publications indicated that low compliance and persistence rates for osteoporosis therapies in the real-life setting result in increased rates of fragility fractures. The results emphasize the importance of good treatment compliance and persistence with osteoporosis therapies in order to achieve a significant therapeutic benefit and thereby reduce the burden that osteoporosis and associated fractures place on individuals and healthcare systems.

摘要

与骨质疏松症相关的脆性骨折是一个重大的公共卫生问题。临床试验表明，多种药物——双膦酸盐、雷洛昔芬、降钙素、激素替代疗法、特立帕肽和雷奈酸锶——可以降低骨质疏松症相关脆性骨折的风险。然而，在现实生活中，依从性和持续性较低意味着在这些药物的临床试验中观察到的疗效益处可能无法转化为日常实践中的同等效果。本综述的目的是对回顾性/观察性研究中的依从性和持续性数据进行全面评估，特别参考那些考虑对骨折率影响的研究。检索了美国国立生物技术信息中心（NCBI）的PubMed和科学网数据库，以查找详细介绍对骨质疏松症治疗的依从性、顺应性和持续性进行观察性或回顾性分析的出版物。此外，作者还提供了未通过检索标准检索到的相关研究。总共确定了17篇独特的出版物。对这些出版物的分析表明，在现实生活中，骨质疏松症治疗的依从性和持续性较低导致脆性骨折发生率增加。结果强调了良好的治疗依从性和坚持使用骨质疏松症治疗方法的重要性，以便实现显著的治疗益处，从而减轻骨质疏松症及相关骨折给个人和医疗保健系统带来的负担。