Hsu Chung-Yuan, Chiu Wen-Chan, Chen Jia-Feng, Chou Ching-Lan, Su Yu-Jih, Yu Shan-Fu, Cheng Tien-Tsai
Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123 Ta-Pei Road, Kaohsiung, 833, Taiwan, China.
J Bone Miner Metab. 2015 Sep;33(5):577-83. doi: 10.1007/s00774-014-0621-7. Epub 2014 Sep 21.
There is poor adherence in the management of osteoporotic fractures. We designed a study to investigate adherence to osteoporotic regimens among osteoporotic hip fracture patients and to analyze the risk factors associated with poor compliance. This retrospective chart-review study was carried out using a database of osteoporotic hip fracture patients at a medical center in Taiwan for the period 2001-2007. Adherence was assessed using compliance and persistence. Compliance was calculated by the medication possession ratio (MPR) and persistence by the time from treatment initiation to discontinuation. The MPR and corresponding risk factors for poor compliance (MPR < 80 %) were evaluated for year 1. The year 2 results were analyzed only for those subjects with good compliance (MPR ≥ 80 %) at the end of year 1. There were 366 osteoporotic hip fracture patients (323 women, 43 men) with a mean age of 73.9 ± 7.6 years. Of these, 53.8 % had good compliance for year 1 and 68.5 % for year 2. During 2 years of follow-up, the overall persistence ratio was 33.1 %. The risk factor associated with poor compliance in the first year was index prescription by orthopedists [odds ratio (OR) 1.69, 95 % confidence interval (CI) 1.10-2.59]. Subjects with hypertension (OR 0.69, 95 % CI 0.46-0.99) had good compliance. Index prescription by orthopedists (OR 2.44, 95 % CI 1.31-4.51) was the sole risk factor for poor compliance in year 2. In conclusion, although adherence to osteoporotic regimens was sub-optimal in hip fracture patients, the majority of patients' decreased adherence occurred within the first year. Medical specialties showed different adherences in both year 1 and year 2.
骨质疏松性骨折的管理存在依从性差的问题。我们设计了一项研究，以调查骨质疏松性髋部骨折患者对骨质疏松治疗方案的依从性，并分析与依从性差相关的风险因素。这项回顾性图表审查研究使用了台湾某医疗中心2001年至2007年期间骨质疏松性髋部骨折患者的数据库。依从性通过依从性和持续性进行评估。依从性通过药物持有率（MPR）计算，持续性通过从治疗开始到停药的时间计算。对第1年的MPR及依从性差（MPR < 80%）的相应风险因素进行评估。仅对第1年末依从性良好（MPR≥80%）的受试者分析第2年的结果。共有366例骨质疏松性髋部骨折患者（323例女性，43例男性），平均年龄为73.9±7.6岁。其中，第1年依从性良好的患者占53.8%，第2年为68.5%。在2年的随访期间，总体持续率为33.1%。第1年与依从性差相关的风险因素是骨科医生开具的索引处方[比值比（OR）1.69，95%置信区间（CI）1.10 - 2.59]。患有高血压的受试者（OR 0.69，95% CI 0.46 - 0.99）依从性良好。骨科医生开具的索引处方（OR 2.44，95% CI 1.31 - 4.51）是第2年依从性差的唯一风险因素。总之，尽管髋部骨折患者对骨质疏松治疗方案的依从性不理想，但大多数患者依从性下降发生在第1年内。在第1年和第2年，不同医学专科的依从性表现不同。
