Xie Jing, Tong Angela, Kim Seoyoung C
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America; Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2015 Jan 22;10(1):e0115091. doi: 10.1371/journal.pone.0115091. eCollection 2015.
The effectiveness and safety of bisphosphonates treatment used in the young population have not been well studied. Despite insufficient data on effectiveness and safety of bisphosphonates in young patients, bisphosphonates are still considered in younger patients at high risk for osteoporosis or fracture. The objectives of this study were to identify bisphosphonate initiators aged 10-45 years and describe their clinical characteristics and to assess time trends of bisphosphonate use over the past decade in a large U.S. population-based cohort.
Using the medical and pharmacy claims data from a U.S. commercial insurance (2003-2012), patients aged 10-45 years without malignancy who initiated an oral or intravenous bisphosphonate after at least 1 year of insurance enrollment were selected. Baseline demographics, comorbidities, medications and health care utilization were assessed in the year prior to initiating a bisphosphonate. The trend of bisphosphonate use over time was examined.
There were 9,082 bisphosphonate initiators (0.02% of the same age group in the population). The mean age was 38.1 years and 79.6% female. Osteoporosis was the most common diagnosis (41.2%). At baseline, 10.8% had a diagnosis of fracture and 29.0% had a bone mineral density measured. Of those who used glucocorticoids (39%) at baseline, the mean 1-year cumulative prednisone-equivalent dose was 2,669 milligrams. The use of bisphosphonates in the young population significantly decreased over the past decade (p<0.001).
Among young patients aged 10-45, the use of bisphosphonates was uncommon and significantly decreased over the past decade in the U.S. While most patients initiating bisphosphonates had a diagnosis of osteoporosis and fracture in the preceding year, some had no recorded claims with a diagnosis of fracture, osteoporosis, or long-term glucocorticoids use at baseline. Future research is needed to examine the effectiveness and safety of bisphosphonates in young patients at risk for osteoporosis.
双膦酸盐类药物在年轻人群中的有效性和安全性尚未得到充分研究。尽管关于双膦酸盐类药物在年轻患者中的有效性和安全性数据不足，但对于骨质疏松症或骨折高风险的年轻患者，仍会考虑使用双膦酸盐类药物。本研究的目的是确定年龄在10至45岁之间开始使用双膦酸盐类药物的患者，描述他们的临床特征，并评估过去十年中美国一个大型基于人群的队列中双膦酸盐类药物使用的时间趋势。
利用美国商业保险（2003 - 2012年）的医疗和药房索赔数据，选取年龄在10至45岁之间、无恶性肿瘤且在参保至少1年后开始口服或静脉注射双膦酸盐类药物的患者。在开始使用双膦酸盐类药物前一年评估基线人口统计学、合并症、用药情况和医疗保健利用情况。研究双膦酸盐类药物使用随时间的趋势。
共有9082名开始使用双膦酸盐类药物的患者（占该年龄组人群的0.02%）。平均年龄为38.1岁，女性占79.6%。骨质疏松症是最常见的诊断（41.2%）。基线时，10.8%的患者有骨折诊断，29.0%的患者进行了骨密度测量。在基线时使用糖皮质激素的患者中（39%），1年累计泼尼松等效剂量平均为2669毫克。在过去十年中，年轻人群中双膦酸盐类药物的使用显著减少（p<0.001）。
在美国，年龄在10至45岁的年轻患者中，双膦酸盐类药物的使用并不常见，且在过去十年中显著减少。虽然大多数开始使用双膦酸盐类药物的患者在前一年有骨质疏松症和骨折诊断，但有些患者在基线时没有骨折、骨质疏松症或长期使用糖皮质激素的记录索赔。需要进一步研究以检验双膦酸盐类药物在有骨质疏松症风险的年轻患者中的有效性和安全性。
