Naranjo Antonio, López Rubén, García-Magallón Blanca, Cáceres Laura, Francisco Félix, Jiménez-Palop Mercedes, Ojeda-Bruno Soledad
Department of Rheumatology, Hospital Universitario Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, La Ballena s/n, 35010, Las Palmas, Spain,
Rheumatol Int. 2014 Oct;34(10):1459-63. doi: 10.1007/s00296-014-3014-2. Epub 2014 Apr 12.
The aim of this study was to analyze the longitudinal practice patterns of prophylaxis of glucocorticoid-induced osteoporosis in patients with polymyalgia rheumatica (PMR). Patients diagnosed with PMR were collected retrospectively in two rheumatology departments. In addition to demographic and diagnostic criteria, the chart review included the following information at baseline and at follow-up: doses of prednisone, prescription of calcium, vitamin D and bisphosphonates, bone mass measurement (BMD) and fragility fractures. We analyzed the percentage of patients undergoing BMD and were prescribed a bisphosphonate over the years. We evaluated 158 patients: 117 of them were women, mean age was 73 years, and they had an average follow-up of 4.8 years. 104 patients (66 %) received osteoporosis medication during the first visit, 44 of them were given bisphosphonate. During follow-up, another 30 treatments with bisphosphonate were added (46 % overall) while 37 cases (23 %) received no treatment with calcium or bisphosphonate. BMD was performed in 111 patients (69 %; 53 % of males and 76 % of females). Factors associated with the use of bisphosphonates were female sex (OR 4.4, 95 % CI 4.02-4.86), BMD (OR 2.4, 95 % CI 2.05-2.78) and commencement of treatment after the year 2005 (54 vs 37 %, OR 1.93, 95 % CI 1.60-2.26). No significant differences were found with age, initial doses of prednisone or the hospital. According to recent prevention guidelines, treatment with biphosphonate should have been administered in more than 90 % of patients. Although prophylaxis of glucocorticoid-induced osteoporosis in patients with PMR has increased in the recent years, many patients do not receive prophylaxis with bisphosphonate during the first visit.
本研究的目的是分析风湿性多肌痛（PMR）患者糖皮质激素性骨质疏松症预防的纵向实践模式。在两个风湿病科回顾性收集诊断为PMR的患者。除人口统计学和诊断标准外，病历审查包括基线和随访时的以下信息：泼尼松剂量、钙、维生素D和双膦酸盐的处方、骨量测量（BMD）和脆性骨折。我们分析了多年来接受BMD检查并被处方双膦酸盐的患者百分比。我们评估了158例患者：其中117例为女性，平均年龄73岁，平均随访4.8年。104例患者（66%）在首次就诊时接受了骨质疏松症药物治疗，其中44例接受了双膦酸盐治疗。随访期间，又增加了30例双膦酸盐治疗（总计46%），而37例患者（23%）未接受钙或双膦酸盐治疗。111例患者（69%；男性53%，女性76%）进行了BMD检查。与使用双膦酸盐相关的因素为女性（OR 4.4，95%CI 4.02-4.86）、BMD（OR 2.4，95%CI 2.05-2.78）以及2005年后开始治疗（54%对37%，OR 1.93，95%CI 1.60-2.26）。在年龄、泼尼松初始剂量或医院方面未发现显著差异。根据最近的预防指南，超过90%的患者应接受双膦酸盐治疗。尽管近年来PMR患者糖皮质激素性骨质疏松症的预防有所增加，但许多患者在首次就诊时未接受双膦酸盐预防治疗。
