Department of Clinical and Administrative Pharmacy Sciences, School of Pharmacy, Howard University, Center for Minority Health Services Research, Washington, District of Columbia, USA.
J Womens Health (Larchmt). 2010 May;19(5):847-54. doi: 10.1089/jwh.2009.1441.
To describe long-term prescribing patterns of osteoporosis therapy before and after the Women's Health Initiative (WHI) publication.
We conducted a time-series analysis from 1997 to 2005 using nationally representative data based on office-based physician and hospital ambulatory clinic visits. Bivariate and multivariable analyses were conducted using chi-square tests and logistic regression, respectively, and trends in the prevalence of osteoporosis therapies were evaluated per 6-month (semiannual) intervals. Linear regression and graphic techniques were used to determine statistical differences in the prevalence trends between the two periods.
Overall prevalence of therapeutic or preventive osteoporosis therapy was similar between the WHI periods. However, a significant decrease in estrogen therapy and increases in bisphosphonates, calcium/vitamin D were observed in the period after the WHI publication (p < 0.05). Multiple logistic regression analysis showed older age and white race were associated with a higher likelihood of antiosteoporosis medication (AOM) prescription, and Medicaid insurance type was associated with a lower likelihood of an AOM prescription. Excluding calcium/vitamin D, nonestrogen therapy was more likely to be prescribed in the after-WHI period (office-based physician clinic: [adjusted OR, aOR] 2.49 [2.04-4.04]; hospital-based clinic: aOR 2.42 [1.67-7.50]) Nonestrogen therapy was more prevalent in visits made by older women, women of white race, women with contraindicated conditions for estrogen therapy, and women from the Northeast region.
After the WHI publication, the overall prevalence of osteoporosis therapy did not change; however, a shift from estrogen to nonestrogen therapy was observed after the WHI publication. Black women were less likely to receive nonestrogen antiosteoporosis therapy in hospital-based clinics.
描述妇女健康倡议（WHI）发表前后骨质疏松症治疗的长期处方模式。
我们使用基于办公室医生和医院门诊诊所就诊的全国代表性数据，从 1997 年到 2005 年进行了时间序列分析。使用卡方检验和逻辑回归分别进行了双变量和多变量分析，并评估了每 6 个月（半年度）间隔骨质疏松症治疗的流行率趋势。使用线性回归和图形技术来确定两个时期流行趋势的统计学差异。
WHI 期间，治疗或预防骨质疏松症治疗的总体流行率相似。然而，在 WHI 发表后，雌激素治疗显著减少，双膦酸盐、钙/维生素 D 增加（p < 0.05）。多变量逻辑回归分析表明，年龄较大和白人种族与抗骨质疏松药物（AOM）处方的可能性更高相关，而医疗补助保险类型与 AOM 处方的可能性较低相关。排除钙/维生素 D 后，非雌激素治疗在 WHI 后时期更有可能被开处方（办公室医生诊所：[调整后的 OR，aOR]2.49[2.04-4.04]；医院诊所：aOR 2.42[1.67-7.50]）。非雌激素治疗在年龄较大的女性、白人女性、雌激素治疗禁忌证的女性以及来自东北部地区的女性就诊中更为常见。
WHI 发表后，骨质疏松症治疗的总体流行率没有变化；然而，在 WHI 发表后，雌激素治疗向非雌激素治疗转变。黑人女性在医院诊所接受非雌激素抗骨质疏松治疗的可能性较低。
