HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
Graduate Entry Medicine Royal College of Surgeons in Ireland, Dublin, Ireland.
Age Ageing. 2021 Sep 11;50(5):1649-1656. doi: 10.1093/ageing/afab033.
Adults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common.
This study aimed to investigate factors associated with bone-health medication initiation in older patients attending primary care.
This was a retrospective cohort study.
The study used data from forty-four general practices in Ireland from 2011-2017.
The study included adults aged ≥ 65 years who were naïve to bone-health medication for 12 months.
Overall fracture-risk (based on QFracture) and individual fracture-risk factors were described for patients initiated and not initiated onto medication and compared using generalised linear model regression with the Poisson distribution.
Of 36,799 patients (51% female, mean age 75.4 (SD = 8.4)) included, 8% (n = 2,992) were observed to initiate bone-health medication during the study. One-fifth of all patients (n = 8,193) had osteoporosis or had high fracture-risk but only 21% of them (n = 1,687) initiated on medication. Female sex, older age, state-funded health cover and osteoporosis were associated with initiation. Independently of osteoporosis and co-variates, high 5-year QFracture risk for hip (IRR = 1.33 (95% CI = 1.17-1.50), P < 0.01) and all fractures (IRR = 1.30 (95% CI = 1.17-1.44), P < 0.01) were associated with medication initiation. Previous fracture, rheumatoid arthritis and corticosteroid use were associated with initiation, while liver, kidney, cardiovascular disease, diabetes and oestrogen-only hormone replacement therapy showed an inverse association.
Bone-health medication initiation is targeted at patients at higher fracture-risk but much potential under-treatment remains, particularly in those >80 years and with co-morbidities. This may reflect clinical uncertainty in older multimorbid patients, and further research should explore decision-making in preventive bone medication prescribing.
对于存在脆性骨折高风险的成年人，若无禁忌证，应给予药物治疗，但治疗不足的情况较为常见。
本研究旨在探讨在接受初级保健的老年患者中，与骨健康药物治疗起始相关的因素。
这是一项回顾性队列研究。
该研究使用了 2011 年至 2017 年期间来自爱尔兰 44 家全科诊所的数据。
研究纳入了年龄≥65 岁、12 个月内未使用过骨健康药物的成年人。
对开始和未开始使用药物的患者进行总体骨折风险（基于 QFracture 评估）和个体骨折风险因素描述，并使用广义线性模型回归和泊松分布进行比较。
在 36799 名患者（51%为女性，平均年龄 75.4[标准差 8.4]岁）中，有 8%（n=2992）在研究期间开始使用骨健康药物。所有患者中有五分之一（n=8193）患有骨质疏松症或存在高骨折风险，但只有 21%（n=1687）开始接受药物治疗。女性、年龄较大、享受政府资助的健康保险和骨质疏松症与起始治疗相关。独立于骨质疏松症和协变量，髋部（IRR=1.33（95%CI=1.17-1.50），P<0.01）和所有骨折（IRR=1.30（95%CI=1.17-1.44），P<0.01）的 5 年 QFracture 风险较高与药物起始相关。既往骨折、类风湿关节炎和皮质类固醇使用与起始治疗相关，而肝脏、肾脏、心血管疾病、糖尿病和仅雌激素激素替代疗法则与起始治疗呈负相关。
骨健康药物的起始治疗针对的是骨折风险较高的患者，但仍有很大的潜在治疗不足，特别是在 80 岁以上和合并多种疾病的患者中。这可能反映了老年多病患者临床决策的不确定性，需要进一步研究探索预防性骨药物处方决策。
