Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave JJN1-200, Cleveland, OH, 44195, USA.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Arch Osteoporos. 2018 Sep 28;13(1):103. doi: 10.1007/s11657-018-0517-6.
Overtreatment of osteoporosis increases costs and puts patients at unnecessary risk of experiencing adverse drug events. In the Patient Activation After DXA Receipt Notification (PAADRN) trial, we found that 8% of individuals with no indication for therapy were recommended a new osteoporosis medication or continuation of an existing medication.
There is a robust body of literature addressing undertreatment in osteoporosis, but limited data addressing overtreatment. Understanding overtreatment is important to minimize harm and decrease costs.
One of the pre-specified post hoc analyses of the PAADRN trial, a randomized, controlled, pragmatic clinical trial, was to quantify and identify risk factors associated with osteoporosis overtreatment. PAADRN included patients ≥ 50 years of age presenting for bone density testing between February, 2012, and August, 2014, at three US healthcare systems. We assessed 20,397 patients for eligibility and randomized 7749. Intervention patients received a tailored letter containing their dual-energy X-ray absorptiometry (DXA) results and an educational osteoporosis brochure. Control patients received usual care. Using the National Osteoporosis Foundation treatment guidelines, we defined overtreatment as the receipt of osteoporosis pharmacotherapy 12 weeks after DXA when treatment was not indicated. We evaluated the relationship between the following baseline variables-sex, race/ethnicity, educational attainment, and differences across health systems-and overtreatment using a series of multivariable logistic regression models.
Among 3602 patients with no apparent indication for osteoporosis treatment, 292 (8.1%; 95% CI, 7.22 to 9.00%) received a new prescription for osteoporosis pharmacotherapy or were instructed to continue an existing medication (presumed overtreatment). Presumed overtreatment was more common among participants with prior DXA history, those who reported a history of osteoporosis or low bone mass, and those referred for testing by family medicine providers.
In our sample of older adults, overuse of osteoporosis pharmacotherapy was only 8.1%. Nevertheless, overtreatment exposes patients to possible risk with negligible chance of benefit and should be minimized.
clinicaltrials.gov identifier: NCT01507662.
骨质疏松症的过度治疗会增加成本，并使患者面临不必要的药物不良反应风险。在 DXA 检查结果通知后患者激活（PAADRN）试验中，我们发现 8%没有治疗指征的患者被建议使用新的骨质疏松症药物或继续使用现有药物。
关于骨质疏松症的治疗不足已有大量文献，但关于过度治疗的数据有限。了解过度治疗的情况对于最大限度地减少危害和降低成本很重要。
PAADRN 试验的一项预先设定的事后分析是量化和确定与骨质疏松症过度治疗相关的危险因素。PAADRN 是一项随机、对照、实用的临床试验，纳入 2012 年 2 月至 2014 年 8 月期间在美国三个医疗保健系统就诊进行骨密度检测的年龄≥50 岁的患者。我们评估了 20397 名患者的入组资格，并对 7749 名患者进行了随机分组。干预组患者收到了一份个性化的信函，其中包含他们的双能 X 射线吸收仪（DXA）结果和一份骨质疏松症教育小册子。对照组患者接受常规护理。我们使用国家骨质疏松基金会治疗指南，将 DXA 后 12 周内接受骨质疏松症药物治疗而无治疗指征定义为过度治疗。我们使用一系列多变量逻辑回归模型评估了以下基线变量（性别、种族/民族、教育程度和医疗系统差异）与过度治疗之间的关系。
在 3602 名无明显骨质疏松症治疗指征的患者中，有 292 名（8.1%；95%CI，7.22 至 9.00%）接受了新的骨质疏松症药物处方或被指示继续服用现有药物（假定过度治疗）。在有 DXA 检查史、报告骨质疏松或低骨量病史以及家庭医学提供者推荐进行检查的患者中，假定过度治疗更为常见。
在我们的老年患者样本中，过度使用骨质疏松症药物治疗的比例仅为 8.1%。然而，过度治疗会使患者面临可能的风险，而获益的可能性微乎其微，因此应尽量减少过度治疗。
clinicaltrials.gov 标识符：NCT01507662。
