患者坚持长期使用阿伦膦酸钠治疗的原因。
Patients' reasons for adhering to long-term alendronate therapy.
机构信息
Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Rome, Italy.
Department of Public Health and Infectious Diseases, "Sapienza" University, Rome, Italy.
出版信息
Osteoporos Int. 2019 Aug;30(8):1627-1634. doi: 10.1007/s00198-019-05010-w. Epub 2019 May 14.
UNLABELLED
We aimed to determine patients' reasons for continuing alendronate therapy over 5 years by administering a questionnaire. Bone mineral density, fractures, drugs, Charlson comorbidity index, and lifestyle factors were also considered. Education and awareness of the disease appeared highly associated with good alendronate adherence while worsening health status with discontinuation.
INTRODUCTION
Aim of this study was to investigate patients' reasons for adhering to long-term alendronate therapy (more than 5 years), as data is not available in the current literature regarding the reasons behind long-term adherence.
METHODS
We studied 204 long-term adherent alendronate users: 65 postmenopausal outpatients still adherent (group C, years on treatment = 8.70 ± 1.31) were compared to 139 age-matched patients who discontinued therapy (group S, years on treatment = 8.64 ± 1.43). We evaluated main biochemical parameters, BMD values, fractures, and Charlson comorbidity index (CCI). A questionnaire was administered to analyze the reasons for long-term adherence.
RESULTS
There were no significant differences between groups concerning baseline DXA values, number of fractures, and CCI. A higher education level was observed in group C (C 54% vs S 35% of patients, p = 0.001). At the time of interview, there was a significantly higher number of patients with a CCI of two in group S compared to the beginning of treatment (56% vs 43%, p = 0.04), together with a higher number of patients taking more than 3 drugs (22% vs 11%, p = 0.01) compared to basal evaluation. Forty-seven percent of patients reported new diseases during the treatment as the main reason for stopping alendronate. A multivariate, stepwise logistic regression analysis showed that awareness of the disease was highly associated with adherence (OR = 0.20; 95% CI 0.045-0.93, p = 0.04) followed by higher education (OR = 0.526, 95% CI 0.345-0.801, p = 0.003). Worsening of CCI was associated with discontinuation (OR = 2.75, 95% CI 1.033-7.324, p = 0.04).
CONCLUSIONS
Education and disease awareness are associated with long-term alendronate adherence while competing health problems negatively impact adherence.
目的
通过问卷调查确定患者在 5 年内继续服用阿仑膦酸钠的原因。还考虑了骨密度、骨折、药物、Charlson 合并症指数和生活方式因素。教育和对疾病的认识似乎与良好的阿仑膦酸钠依从性高度相关，而健康状况恶化则与停药有关。
引言
本研究旨在探讨患者长期（超过 5 年）服用阿仑膦酸钠的原因，因为目前文献中尚无关于长期依从性背后原因的数据。
方法
我们研究了 204 名长期服用阿仑膦酸钠的依从性患者：65 名仍在接受治疗的绝经后门诊患者（C 组，治疗年限=8.70±1.31 年）与 139 名年龄匹配的停药患者（S 组，治疗年限=8.64±1.43 年）进行比较。我们评估了主要生化参数、BMD 值、骨折和 Charlson 合并症指数（CCI）。我们进行了问卷调查，以分析长期依从的原因。
结果
两组在基线 DXA 值、骨折数量和 CCI 方面无显著差异。C 组的教育水平较高（C 组 54% vs S 组 35%的患者，p=0.001）。在访谈时，与治疗开始时相比，S 组有更多的 CCI 为 2 的患者（56% vs 43%，p=0.04），同时有更多的患者服用超过 3 种药物（22% vs 11%，p=0.01）与基线评估相比。47%的患者在治疗期间因新发病作为停止服用阿仑膦酸钠的主要原因。多变量逐步逻辑回归分析显示，对疾病的认识与依从性高度相关（OR=0.20；95%CI 0.045-0.93，p=0.04），其次是较高的教育水平（OR=0.526，95%CI 0.345-0.801，p=0.003）。CCI 的恶化与停药相关（OR=2.75，95%CI 1.033-7.324，p=0.04）。
结论
教育和对疾病的认识与长期服用阿仑膦酸钠相关，而健康问题则对依从性产生负面影响。
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