Mikyas Yeshi, Agodoa Irene, Yurgin Nicole
Amgen Inc, One Amgen Center Drive, MS 28-3-A, Thousand Oaks, CA, 91320, US,
Appl Health Econ Health Policy. 2014 Jun;12(3):267-77. doi: 10.1007/s40258-013-0078-1.
Male osteoporosis is an increasingly important public health concern. Although several medications are approved for the treatment of osteoporosis, medication non-adherence and the associated consequences are not well documented in male populations. Our objective was to identify and summarize the current knowledge related to osteoporotic medication adherence, the potential implications of non-adherence to the medication, and the cost of osteoporosis-related fractures and health-resource utilization in men.
Two separate systematic searches were conducted concurrently: one to identify literature reporting male-specific adherence to anti-osteoporotic medication and the clinical consequence of non-adherence in men, and the other to identify literature reporting the cost and resource burden of osteoporosis-related fractures in men. The PubMed, MEDLINE, EMBASE, and Cochrane databases were searched using a date range of 1 January 1998 to 30 June 2012, and citations were screened based on pre-defined criteria.
The percentage of males adherent to bisphosphonates [medication possession ratio (MPR) >0.8] over a 1-year period ranged from 32% to 64%. The data imply worse clinical outcomes with treatment non-adherence. Costs and resource use associated with osteoporosis-related fractures in men are high, with hip fractures generating the most cost.
One-third to two-thirds of men are not adherent to bisphosphonates. Non-adherence is associated with increased fracture risk. Estimates of direct and indirect osteoporosis-related fracture costs are also substantial in men, and may even be more costly than in women. More robust data would better inform disease management initiatives that could improve adherence to medication and outcomes in men with osteoporosis.
男性骨质疏松症是一个日益重要的公共卫生问题。尽管有几种药物已被批准用于治疗骨质疏松症，但在男性群体中，药物不依从性及其相关后果尚无充分记录。我们的目的是识别并总结当前与骨质疏松症药物依从性、不依从药物的潜在影响以及男性骨质疏松相关骨折的成本和卫生资源利用情况相关的知识。
同时进行两项独立的系统检索：一项用于识别报告男性特异性抗骨质疏松药物依从性及男性不依从的临床后果的文献，另一项用于识别报告男性骨质疏松相关骨折的成本和资源负担的文献。使用1998年1月1日至2012年6月30日的日期范围检索PubMed、MEDLINE、EMBASE和Cochrane数据库，并根据预先定义的标准筛选文献。
在1年期间，男性服用双膦酸盐类药物的依从率（药物持有率[MPR]>0.8）在32%至64%之间。数据表明治疗不依从会导致更差的临床结果。男性骨质疏松相关骨折的成本和资源使用很高，髋部骨折产生的成本最高。
三分之一至三分之二的男性不依从双膦酸盐类药物治疗。不依从与骨折风险增加相关。男性骨质疏松相关骨折的直接和间接成本估计也很高，甚至可能比女性更高。更有力的数据将为疾病管理举措提供更好的信息，从而改善男性骨质疏松症患者的药物依从性和治疗效果。
