Höer Ariane, Seidlitz Cornelia, Gothe Holger, Schiffhorst Guido, Olson Melvin, Hadji Peyman, Häussler Bertram
IGES Institut, Friedrichstrasse 180, D-10117 Berlin, Germany;
Patient Prefer Adherence. 2009 Nov 3;3:25-30.
Oral bisphosphonates have been shown to reduce the risk of fractures in patients with osteoporosis. It can be assumed that the clinical effectiveness of oral bisphosphonates depends on persistence with therapy.
The influence of persistence with and adherence to oral bisphosphonates on fracture risk in a real-life setting was investigated. Data from 4451 patients with a defined index prescription of bisphosphonates were included. Fracture rates within 180, 360, and 720 days after index prescription were compared between persistent and non-persistent patients. In an extended Cox regression model applying multiple event analysis, the influence of adherence was analyzed. Persistence was defined as the duration of continuous therapy; adherence was measured in terms of the medication possession ratio (MPR).
In patients with a fracture before index prescription, fracture rates were reduced by 29% (p = 0.025) comparing persistent and non-persistent patients within 180 days after the index prescription and by 45% (p < 0.001) within 360 days. The extended Cox regression model showed that good adherence (MPR >/= 0.8) reduced fracture risk by about 39% (HR 0.61, 95% CI 0.47-0.78; p < 0.01).
In patients with osteoporosis-related fractures, good persistence and adherence to oral bisphosphonates reduced fracture risk significantly.
口服双膦酸盐已被证明可降低骨质疏松症患者的骨折风险。可以假定口服双膦酸盐的临床疗效取决于治疗的持续性。
研究了在实际临床环境中，口服双膦酸盐的持续性和依从性对骨折风险的影响。纳入了4451例有明确双膦酸盐索引处方的患者的数据。比较了持续用药和未持续用药患者在索引处方后180天、360天和720天内的骨折发生率。在应用多事件分析的扩展Cox回归模型中，分析了依从性的影响。持续性定义为连续治疗的持续时间；依从性通过药物持有率（MPR）来衡量。
在索引处方前有骨折的患者中，索引处方后180天内，持续用药和未持续用药患者相比，骨折发生率降低了29%（p = 0.025），360天内降低了45%（p < 0.001）。扩展Cox回归模型显示，良好的依从性（MPR≥0.8）可使骨折风险降低约39%（风险比0.61，95%置信区间0.47 - 0.78；p < 0.01）。
在患有骨质疏松相关骨折的患者中，良好的口服双膦酸盐持续性和依从性可显著降低骨折风险。
