Paris Descartes University, Paris, France.
Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27, Rue du Faubourg St Jacques, 75014, Paris, France.
Osteoporos Int. 2017 Dec;28(12):3339-3345. doi: 10.1007/s00198-017-4188-8. Epub 2017 Aug 29.
Using case vignette methodology, this study shows that only 4% of patients are maintained on oral bisphosphonates over 5 years, and prescribers switch or stop the treatment in 20-30% of cases at each visit. There are few determinants of these changes. More information on appropriate follow-up could help in patients' management.
Persistence to oral bisphosphonates, the most commonly prescribed anti-osteoporotic treatments, is low. The aim of this study was to evaluate the role of rheumatologists on the treatment patterns, and to assess the determinants of treatment changes.
We used the methodology of case vignettes with the participation of 142 rheumatologists. Three baseline clinical vignettes were presented: (1) the physician was asked to indicate the most appropriate period to schedule the next visit over 5 years, (2) the physician was tested about parameters for follow-up (including traps), and (3) various results (both clinical, biological, densitometric, and radiological) were given by random and analyzed as determinants of treatment changes.
The study allowed assessment of 426 virtual clinical cases. Clinical examinations, patient's height, inquiries about falls, and adherence to treatment were deemed necessary in > 90% of cases. Bone mineral density was measured in 22, 40, and 71% of cases at 2, 3, and 5 years, respectively. Dental follow-up was recommended in less than 25% of cases. Only 4.2% of patients were maintained on the same treatment at 5 years, and a change of treatment (stop or switch) occurs in 20-30% of cases at each visit. Significant determinants were adherence to treatment, serum C-terminal crosslinking telopeptide of type 1 collagen (CTX) value, change in patient's height, and the occurrence of an incident vertebral fracture.
Our study shows that maintenance of oral bisphosphonate in postmenopausal women managed by rheumatologists is low; there are few determinants of these changes and more information on appropriate follow-up could help in patients' management.
本研究采用病例实例方法表明，仅有 4%的患者在 5 年内持续服用口服双膦酸盐，并且在每次就诊时，20-30%的情况下，医生会更换或停止治疗。这些变化的决定因素很少。更多关于适当随访的信息可能有助于患者的管理。
最常开的抗骨质疏松治疗药物——口服双膦酸盐的患者坚持治疗率低。本研究的目的是评估风湿病医生在治疗模式中的作用，并评估治疗变化的决定因素。
我们采用病例实例方法，有 142 名风湿病医生参与。提出了三个基线临床实例：（1）医生被要求指出在 5 年内安排下一次就诊的最合适时间；（2）医生接受了关于随访参数（包括陷阱）的测试；（3）通过随机给予各种结果（临床、生物学、骨密度和影像学），并分析其作为治疗变化的决定因素。
研究评估了 426 个虚拟临床病例。超过 90%的病例需要进行临床检查、患者身高测量、询问跌倒情况和治疗依从性。在 2、3 和 5 年时，分别有 22%、40%和 71%的病例测量了骨密度。不到 25%的病例建议进行牙科随访。仅有 4.2%的患者在 5 年内仍接受相同的治疗，每次就诊时，20-30%的患者会更换或停止治疗。显著的决定因素是治疗的依从性、血清 1 型胶原 C 端交联肽（CTX）值、患者身高的变化以及发生椎骨骨折的情况。
我们的研究表明，由风湿病医生管理的绝经后妇女服用口服双膦酸盐的维持率低；这些变化的决定因素很少，更多关于适当随访的信息可能有助于患者的管理。
