Overman R A, Gourlay M L, Deal C L, Farley J F, Brookhart M A, Layton J B
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,
Osteoporos Int. 2015 May;26(5):1515-24. doi: 10.1007/s00198-014-3022-9. Epub 2015 Jan 20.
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.
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.
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.
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.
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.
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%。
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。
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）。
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）。
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。
