Jacob L, Dreher M, Kostev K, Hadji P
Department of Biology, École Normale Supérieure de Lyon, Lyon, France.
Department of Gynecology and Obstetrics, Philipps-Universität Marburg, Marburg, Germany.
Osteoporos Int. 2016 Mar;27(3):963-969. doi: 10.1007/s00198-015-3378-5. Epub 2015 Oct 30.
The purpose of this study is to analyze treatment persistence in patients with osteoporosis after fracture diagnosis in German primary care practices. We found that pain increased treatment persistence. One key next step is to demonstrate whether or not this pain is related to fracture.
To analyze treatment persistence in patients with osteoporosis after fracture diagnosis in German primary care practices.
This study included postmenopausal women with osteoporosis aged between 40 and 90 years from 1188 general and 175 orthopedist practices in Germany. Treatment started between 2004 and 2013. The primary outcome measure was treatment persistence within 12 months after therapy initiation. Discontinuation of treatment was defined as a period of at least 90 days without therapy. Persistence analyses were carried out using Kaplan-Meier curves and log-rank tests, and the analyses of the impact of fracture on discontinuation risk were based on Cox regression models (with and without adjustment for pain medications).
Thirteen thousand nine hundred seventy-five subjects (mean age = 74.8 years) were included in the group with fracture before therapy initiation and 18,138 (mean age = 72.7 years) in the group without fracture. Within 12 months after treatment initiation, therapy persistence increased with the delay between osteoporosis diagnosis and therapy initiation, rising from 40.7% when the delay was lower than or equal to 12 months to 44.3% when it exceeded 36 months (p value <0.0001). Fracture only decreased the risk of treatment discontinuation when the model was not adjusted for pain medications (HR = 0.95, 95% CI 0.93-0.98, p value <0.0001).
Pain increased treatment persistence in women with osteoporosis and fracture. Further studies are needed to better understand factors influencing persistence.
本研究旨在分析德国初级医疗实践中骨质疏松症患者骨折诊断后的治疗持续性。我们发现疼痛会增加治疗持续性。接下来的一个关键步骤是证明这种疼痛是否与骨折相关。
分析德国初级医疗实践中骨质疏松症患者骨折诊断后的治疗持续性。
本研究纳入了德国1188家普通诊所和175家骨科诊所中年龄在40至90岁之间的绝经后骨质疏松症女性。治疗开始于2004年至2013年之间。主要结局指标是治疗开始后12个月内的治疗持续性。治疗中断定义为至少90天未接受治疗的时间段。使用Kaplan-Meier曲线和对数秩检验进行持续性分析，基于Cox回归模型（有或无疼痛药物调整）分析骨折对中断风险的影响。
治疗开始前有骨折的组纳入了13975名受试者（平均年龄 = 74.8岁），无骨折的组纳入了18138名受试者（平均年龄 = 72.7岁）。治疗开始后12个月内，治疗持续性随着骨质疏松症诊断与治疗开始之间的延迟时间增加而增加，当延迟时间小于或等于12个月时为40.7%，超过36个月时升至44.3%（p值<0.0001）。仅在模型未对疼痛药物进行调整时，骨折才降低了治疗中断风险（HR = 0.95，95% CI 0.93 - 0.98，p值<0.0001）。
疼痛增加了患有骨质疏松症和骨折的女性的治疗持续性。需要进一步研究以更好地了解影响持续性的因素。
