Gu Tao, Eisenberg Lawrence Debra F, Stephenson Judith J, Yu Jingbo
HealthCore, Wilmington, DE, USA.
Merck & Co., Inc., Kenilworth, NJ, USA.
Clin Interv Aging. 2016 Feb 15;11:1-8. doi: 10.2147/CIA.S97593. eCollection 2016.
Noncompliance with bisphosphonate therapy among osteoporosis patients attenuates the reduction of fracture risk. The objective of this study was to assess physicians' prescribing considerations, preferences for osteoporosis treatments, and perceptions of patients' compliance with oral bisphosphonates.
This was an online survey of US physicians identified in the HealthCore Integrated Research Database (HIRD(SM)) as prescribing oral bisphosphonates to women aged ≥55 years. The survey gauged physicians' prescribing considerations and preferences for various types of osteoporosis medications. The physicians were asked to predict patient persistence and compliance, and rate various reasons for noncompliance.
Bone mineral density, long-term medication use (eg, corticosteroids), and a history of fracture were ranked as major considerations by 94.9%, 88.6%, and 86.7% of participating physicians (N=158), respectively, when deciding whether to treat an osteoporosis patient. Most physicians expressed a preference for prescribing weekly or monthly oral bisphosphonates, for both newly diagnosed patients (54.4% and 34.2%, respectively) and long-term users of oral bisphosphonates (40.5% and 36.1%, respectively). Most physicians (23.4% always, 58.9% sometimes) incorporated a drug holiday into their prescribing patterns. Although most physicians predicted that more than half of the patients would comply with the prescribed medication for at least a year, 17.7% predicted that less than half of the patients would be compliant in the 1st year, and 29.7% predicted the same result for compliance beyond 1 year. In the opinion of the majority of physicians, the major reasons for noncompliance with oral bisphosphonates were intolerance of a medication due to a gastrointestinal condition (71.5%) and medication side effects (69.6%).
US physicians consider several relevant risk factors when deciding whether to prescribe pharmacotherapy and exhibit a preference for weekly or monthly regimens. The physicians estimated a substantial minority of the patients to be noncompliant with oral bisphosphonates, for reasons including primarily gastrointestinal intolerance and medication-related side effects.
骨质疏松症患者不依从双膦酸盐治疗会削弱骨折风险的降低。本研究的目的是评估医生的处方考量、对骨质疏松症治疗的偏好以及对患者口服双膦酸盐依从性的看法。
这是一项对在HealthCore综合研究数据库（HIRD(SM)）中被确定为给年龄≥55岁女性开口服双膦酸盐处方的美国医生进行的在线调查。该调查衡量了医生对各种类型骨质疏松症药物的处方考量和偏好。医生们被要求预测患者的持续用药情况和依从性，并对不依从的各种原因进行评分。
在决定是否治疗骨质疏松症患者时，94.9%、88.6%和86.7%的参与医生（N = 158）分别将骨密度、长期用药（如皮质类固醇）和骨折史列为主要考量因素。大多数医生表示，对于新诊断患者（分别为54.4%和34.2%）以及口服双膦酸盐的长期使用者（分别为40.5%和36.1%），他们更倾向于开每周或每月一次的口服双膦酸盐处方。大多数医生（23.4%总是如此，58.9%有时如此）在其处方模式中纳入了药物假期。尽管大多数医生预测超过一半的患者会至少一年依从所开药物治疗，但17.7%的医生预测不到一半的患者在第一年会依从，29.7%的医生预测一年后依从情况也会如此。在大多数医生看来，口服双膦酸盐不依从的主要原因是胃肠道疾病导致的药物不耐受（71.5%）和药物副作用（69.6%）。
美国医生在决定是否开药物治疗处方时会考虑几个相关风险因素，并表现出对每周或每月治疗方案的偏好。医生们估计有相当一部分患者不依从口服双膦酸盐治疗，主要原因包括胃肠道不耐受和药物相关副作用。
