Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota.
J Clin Endocrinol Metab. 2019 May 1;104(5):1631-1636. doi: 10.1210/jc.2019-00193.
Several treatments are available to reduce the risk of fragility fractures associated with osteoporosis. The choice of treatment requires knowledge of patients' values and preferences. The aim of the present study was to summarize what is known about the values and preferences relevant to the management of osteoporosis in women.
We conducted a comprehensive search of several databases for studies reported in any language that had included women who had already started or were about to start any pharmacological therapy for osteoporosis. Pairs of reviewers independently selected the studies and extracted the data. The results were synthesized narratively.
We included 26 studies reporting on 15,348 women (mean age, 66 years). The women considered the effectiveness and adverse events equally, followed by the convenience of taking the drug and its effect on daily routine (less frequent dosing was preferred, the oral route was preferred, and the injectable route was preferred over oral if given less frequently). The treatment cost and duration were less important factors for decision making. Fear of breast cancer and fear of resuming uterine bleeding were common reasons for not choosing estrogen therapy. Calcium and vitamin D were viewed as safe and natural. Across the studies, the preferences were not affected by age, previous drug exposure, or employment status.
Women starting osteoporosis medications value effectiveness and side effects equally and prefer medications given less frequently. Injectable drugs appear acceptable if given less frequently. More research on patient values and preferences is needed to guide decision making in osteoporosis.
有多种治疗方法可降低与骨质疏松症相关的脆性骨折风险。治疗方法的选择需要了解患者的价值观和偏好。本研究的目的是总结与女性骨质疏松症管理相关的价值观和偏好。
我们全面检索了多种数据库，以获取报告任何语言的研究，这些研究纳入了已经开始或即将开始任何骨质疏松症药物治疗的女性。由两名评审员独立选择研究并提取数据。结果以叙述性方式综合。
我们纳入了 26 项研究，共纳入了 15348 名女性（平均年龄 66 岁）。女性同等考虑药物的有效性和不良反应，其次是药物服用的便利性及其对日常生活的影响（更喜欢剂量较少、更喜欢口服途径、如果较少频率给予则更喜欢注射途径而不是口服途径）。治疗费用和持续时间是不太重要的决策因素。对乳腺癌的恐惧和对恢复子宫出血的恐惧是不选择雌激素治疗的常见原因。钙和维生素 D 被认为是安全和自然的。在所有研究中，偏好不受年龄、先前药物暴露或就业状况的影响。
开始使用骨质疏松症药物的女性同等重视药物的有效性和不良反应，并且更喜欢剂量较少的药物。如果频率较低，注射药物似乎可以接受。需要更多关于患者价值观和偏好的研究来指导骨质疏松症的决策。
