STATinMED Research, Ann Arbor, MI, USA.
Eli Lilly and Company, Indianapolis, IN, USA.
Osteoporos Int. 2017 Aug;28(8):2485-2494. doi: 10.1007/s00198-017-4072-6. Epub 2017 May 23.
Our aim was to evaluate the gap in osteoporosis treatment and the impact of osteoporosis treatment on subsequent fragility fractures. We found osteoporosis medication use lowered risk of subsequent fractures by 21% and that black race, higher CCI scores, dementia, and kidney diseases reduced the likelihood of osteoporosis medication use.
The goal of this study was to evaluate the predictors of osteoporosis medication use and compare the risk of fragility fractures within 1 year of a fragility fracture between osteoporosis treated and untreated women.
We conducted a retrospective, observational cohort study using the national Medicare database. Elderly women (≥65 years) who were hospitalized or had an outpatient/ER service for fragility fracture between January 1, 2011 and December 31, 2011 were included. The outcomes of interest were the correlates of and time-to-osteoporosis medication use and risk of a subsequent fracture within 12 months for treated and untreated women. Cox regression was used to evaluate the predictors of treatment use and the risk of fracture based on treatment status.
Women (28,722) (27.7%) were treated with osteoporosis medication within 12 months of index fracture, and 74,979 (72.2%) were untreated. A number of patient characteristics were associated with a reduced likelihood of osteoporosis medication use, including black race, higher Charlson comorbidity index scores, presence of dementia, and kidney diseases in the baseline. The predictor most strongly and positively associated with osteoporosis medication use after fracture was osteoporosis medication use before fragility fracture (HR = 7.87; 95% CI 7.67-8.07). After adjusting for baseline characteristics, osteoporosis medication use lowered the risk of subsequent fractures by 21% (HR = 0.79, 95% CI 0.75-0.83) over 12 months compared to women without treatment.
Demographics and clinical characteristics were strong predictors of osteoporosis medication use. In the US Medicare population, osteoporosis treatment significantly reduced the risk of fragility fractures.
评估骨质疏松症治疗中的差距以及骨质疏松症治疗对随后脆性骨折的影响。结果发现，骨质疏松症药物治疗可使后续骨折风险降低 21%，而黑种人、较高的 CCI 评分、痴呆和肾脏疾病则降低了骨质疏松症药物治疗的可能性。
本研究旨在评估骨质疏松症药物治疗的预测因素，并比较骨质疏松症治疗与未治疗女性在脆性骨折后 1 年内发生脆性骨折的风险。
我们进行了一项回顾性、观察性队列研究，使用国家医疗保险数据库。纳入 2011 年 1 月 1 日至 12 月 31 日期间因脆性骨折住院或接受门诊/急诊服务的 65 岁以上女性。感兴趣的结局是治疗和未治疗女性骨质疏松症药物治疗的相关性以及骨质疏松症药物治疗的时间，以及 12 个月内发生后续骨折的风险。Cox 回归用于评估基于治疗状态的治疗使用和骨折风险的预测因素。
28722 名女性（27.7%）在索引骨折后 12 个月内接受了骨质疏松症药物治疗，74979 名女性（72.2%）未接受治疗。许多患者特征与骨质疏松症药物治疗的可能性降低有关，包括黑种人、较高的 Charlson 合并症指数评分、痴呆和基线肾脏疾病。骨折后与骨质疏松症药物治疗最密切相关且呈阳性的预测因素是脆性骨折前使用骨质疏松症药物治疗（HR7.87；95%CI7.67-8.07）。调整基线特征后，与未治疗的女性相比，骨质疏松症药物治疗在 12 个月内可使随后骨折的风险降低 21%（HR0.79，95%CI0.75-0.83）。
人口统计学和临床特征是骨质疏松症药物治疗的有力预测因素。在美国医疗保险人群中，骨质疏松症治疗显著降低了脆性骨折的风险。
