Gehlbach Stephen, Hooven Frederick H, Wyman Allison, Diez-Perez Adolfo, Adachi Jonathan D, Luo Xuemei, Bushmakin Andrew G, Anderson Frederick A
University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
Hospital del Mar, Autonomous University of Barcelona, Spain.
PLoS One. 2013 Dec 20;8(12):e82840. doi: 10.1371/journal.pone.0082840. eCollection 2013.
To assess patterns of anti-osteoporosis medication (AOM) use over 3 years among women at high risk of major fracture.
The GLOW registry follows a cohort of more than 40,000 women aged ≥ 55 from 615 primary care practices in 10 countries. Self-administered surveys (baseline, 12, 24, and 36 months) collected data on patient characteristics, perception of fracture risk, and AOM use. FRAX scores were calculated from the baseline surveys and women classified as high risk if their FRAX 10-year probability of major fracture was ≥ 20%.
A total of 5774 women were classified as at high risk and had complete data over 3 years. At baseline, 2271 (39%) reported receiving AOM, 739 (13%) reported prior but not current use, and 2764 (48%) said they had never used AOM. Over 3 years, 85% of baseline non-users continued as non-users and 15% initiated AOM; among baseline users, 49% continued the same medication class, 29% stopped AOM, and 12% switched. Women who stopped AOM were less likely to self-report osteoporosis (HR 0.56, 95% CI 0.42-0.75) than women who continued AOM. Compared with non-users who did not begin treatment, women initiating AOM were more likely to report a diagnosis of osteoporosis (HR 11.3, 95% CI 8.2-15.5) or osteopenia (HR 4.1, 95% CI 2.9-5.7) and be very concerned about osteoporosis (HR 1.9, 95% CI 1.3-2.8).
Less than 40% of women at high risk of fracture reported taking AOM. Women who stopped AOM were less likely to believe they have osteoporosis. Women who initiated treatment appeared motivated primarily by a diagnosis of osteoporosis or osteopenia and concern about the condition.
评估主要骨折高风险女性在3年期间抗骨质疏松药物（AOM）的使用模式。
GLOW注册研究跟踪了来自10个国家615家初级保健机构的40000多名55岁及以上女性队列。自行填写的调查问卷（基线、12个月、24个月和36个月）收集了患者特征、骨折风险认知和AOM使用情况的数据。根据基线调查计算FRAX评分，如果女性的FRAX 10年主要骨折概率≥20%，则被归类为高风险。
共有5774名女性被归类为高风险，且有3年的完整数据。在基线时，2271名（39%）报告正在接受AOM治疗，739名（13%）报告曾使用过但目前未使用，2764名（48%）表示从未使用过AOM。在3年期间，85%的基线未使用者持续未使用，15%开始使用AOM；在基线使用者中，49%继续使用同一类药物，29%停止使用AOM，12%更换了药物。与继续使用AOM的女性相比，停止使用AOM的女性自我报告患骨质疏松症的可能性较小（风险比0.56，95%置信区间0.42 - 0.75）。与未开始治疗的未使用者相比，开始使用AOM的女性更有可能报告患有骨质疏松症（风险比11.3，95%置信区间8.2 - 15.5）或骨质减少（风险比4.1，95%置信区间2.9 - 5.7），并且非常担心骨质疏松症（风险比1.9，95%置信区间1.3 - 2.8）。
骨折高风险女性中不到40%报告正在服用AOM。停止使用AOM的女性认为自己患有骨质疏松症的可能性较小。开始治疗的女性似乎主要是出于骨质疏松症或骨质减少的诊断以及对该病的担忧。
