Denver VA Medical Center, 1055 Clermont St, Research 151, Denver, CO 80220, USA.
Osteoporos Int. 2011 Jan;22(1):305-15. doi: 10.1007/s00198-010-1201-x. Epub 2010 Apr 1.
We applied regression techniques to a large cohort of patients to understand why certain patients are prescribed medications to prevent glucocorticoid-induced osteoporosis (GIO). Rates of prescriptions to prevent osteoporosis were low. The presence of drugs and disorders associated with osteoporosis and gastrointestinal conditions actually are associated with a decreased likelihood of receiving osteoporosis-preventing medications.
To understand why some patients are prescribed medications to prevent GIO while other patients are not, we examined whether there is an association among osteoporosis-inducing medical conditions or medications and prescriptions for osteoporosis prophylaxis in a large cohort of rheumatoid arthritis patients on chronic glucocorticoids.
Department of Veterans' Affairs national administrative databases were used to construct a cohort (n = 9,605) and provide the data for this study. Multivariate logistic regression was performed to determine medical conditions and medications associated with dispensing of GIO-preventive medications, controlling for sociodemographic variables, comorbidities, glucocorticoid dosage, prior fractures, and rheumatoid arthritis severity. A subanalysis examined predictors of early GIO prevention.
Subjects were more likely to receive GIO prophylaxis if they were older, African American, treated with multiple antirheumatic disease-modifying drugs, or received greater glucocorticoid exposure. The prescription of certain drug classes (loop diuretics and anticonvulsants) and conditions (malignancy, renal insufficiency, alcohol abuse, and hepatic disease) were associated with lower likelihood of GIO prophylaxis, despite putative links between these agents/conditions and osteoporosis. The presence of gastrointestinal disorders dramatically decreased likelihood of GIO prophylaxis. Few characteristics predicted the dispensing of GIO-preventing medications within 7 days of the initial glucocorticoid start date.
Rates of prescriptions to prevent osteoporosis in a cohort of older men with rheumatoid arthritis on chronic glucocorticoids were low. Gastrointestinal disorders and drugs and disorders potentially linked to osteoporosis are associated with diminished odds of being prescribed GIO-preventing medications.
我们应用回归技术对大量患者进行分析，以了解为什么某些患者会被开具预防糖皮质激素性骨质疏松症（GIO）的药物。预防骨质疏松症的处方率较低。实际上，存在与骨质疏松症和胃肠道疾病相关的药物和疾病会降低接受骨质疏松症预防药物治疗的可能性。
为了了解为什么有些患者被开具预防 GIO 的药物，而有些患者则没有，我们检查了在使用慢性糖皮质激素的大量类风湿关节炎患者中，是否存在与骨质疏松症相关的医疗条件或药物之间的关联，以及与骨质疏松症预防药物处方之间的关联。
使用退伍军人事务部国家行政数据库构建队列（n=9605）并提供本研究的数据。进行多变量逻辑回归以确定与 GIO 预防药物的配药相关的医疗条件和药物，同时控制社会人口统计学变量、合并症、糖皮质激素剂量、既往骨折和类风湿关节炎严重程度。亚分析检查了 GIO 早期预防的预测因素。
如果患者年龄较大、非裔美国人、接受多种抗风湿疾病修饰药物治疗或接受更大剂量的糖皮质激素，则更有可能接受 GIO 预防。尽管某些药物类别（噻嗪类利尿剂和抗惊厥药）和疾病（恶性肿瘤、肾功能不全、酒精滥用和肝脏疾病）与骨质疏松症存在潜在联系，但这些药物的使用与较低的 GIO 预防可能性相关。胃肠道疾病的存在显著降低了 GIO 预防的可能性。很少有特征可以预测在初始糖皮质激素开始后 7 天内开具 GIO 预防药物。
在接受慢性糖皮质激素治疗的老年男性类风湿关节炎队列中，预防骨质疏松症的处方率较低。胃肠道疾病和可能与骨质疏松症相关的药物和疾病与被开具 GIO 预防药物的可能性降低有关。
