糖皮质激素性骨质疏松症中基于质量指标的抗骨质疏松治疗相关的骨折发生率
Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis.
作者信息
Overman R A, Gourlay M L, Deal C L, Farley J F, Brookhart M A, Layton J B
机构信息
Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA,
出版信息
Osteoporos Int. 2015 May;26(5):1515-24. doi: 10.1007/s00198-014-3022-9. Epub 2015 Jan 20.
UNLABELLED
Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.
INTRODUCTION
The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.
METHODS
A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95% confidence intervals (95% CI) were estimated using weighted Cox proportional hazard models.
RESULTS
Of the 7885 women eligible for the study, 12.1% were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95% CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95% CI 0.47, 0.99) at 3 years.
CONCLUSIONS
AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48% at 1 year and 32% at 3 years.
未标注
人们认为，在使用糖皮质激素的患者中使用抗骨质疏松药物（AOM）可减少骨折。我们发现，绝经后女性使用糖皮质激素至少90天，且在90天内也使用了AOM，与未使用AOM的患者相比，1年内骨折发生率降低48%，3年内骨折发生率降低32%。
引言
本研究的目的是通过评估慢性（≥90天）糖皮质激素（GC）治疗后90天内开始使用抗骨质疏松药物（AOM）对骨质疏松性骨折的影响，探讨坚持质量指标的有效性。
方法
利用2000年至2012年的MarketScan数据库组建了一个新用户队列。纳入的患者为女性，开始使用GC时年龄≥50岁，首次GC填充日剂量≥10mg且持续至少90天。在365天的基线期内，排除曾使用GC或AOM（双膦酸盐、地诺单抗、特立帕肽）、有骨折或癌症诊断的患者。在GC填充前14天或填充后90天内开始使用AOM的患者被视为AOM使用者；未使用者为AOM非使用者。随访从GC填充后91天开始，患者随访至骨折、连续登记中断、AOM非使用者开始使用AOM或研究期结束。使用所有测量的协变量估计AOM接受的倾向评分，并转换为稳定的治疗权重逆概率（IPTW）。使用加权Cox比例风险模型估计加权风险比（HR）和相关的95%置信区间（95%CI）。
结果
在7885名符合研究条件的女性中，12.1%为AOM使用者。使用AOM与较低的骨折发生率相关：1年时加权HR为0.52（95%CI 0.29，0.94），3年时加权HR为0.68（95%CI 0.47，0.99）。
结论
在慢性GC使用后90天内开始使用AOM与1年时骨折减少48%和3年时骨折减少32%相关。
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