Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, NC, USA.
J Bone Miner Res. 2021 Dec;36(12):2309-2316. doi: 10.1002/jbmr.4439. Epub 2021 Sep 25.
The 2020 American Association of Clinical Endocrinologists guidelines for assessing osteoporosis among postmenopausal women stratified postmenopausal women with osteoporosis to "high" and "very-high" fracture risk categories and recommended anabolic agents as initial therapy followed by an antiresorptive agent. Switching the order can blunt the effect of anabolic agents, and failing to follow with an antiresorptive can lead to loss of bone generated by the anabolic agent. It would be helpful to understand the real-world prescribing patterns of anabolic agents. Using the 2010-2015 Medicare 100% osteoporosis database, we assessed patient profiles, teriparatide prescribers, persistence of teriparatide therapy, and antiresorptive agent use after teriparatide discontinuation among elderly women who initiated teriparatide from 2011 to 2013. This study included 14,786 patients. In the year before teriparatide initiation, 30.0% of them had a fracture, 67.6% had a dual energy x-ray absorptiometry scan, 74.4% had a diagnosis of osteoporosis, and 47.9% used antiresorptive agents (non-naïve teriparatide users). Among those who had fractures, 49.4% initiated teriparatide within 3 months postfracture. Teriparatide was prescribed for 37% of users by primary care doctors, 19% by rheumatologists, 13% by endocrinologists, and 7.0% by orthopedists. Median time of teriparatide use was 7.2 months. After teriparatide discontinuation, 40.8% switched to antiresorptive agents (31.9% among naïve teriparatide users, 50.5% among non-naïve users). Among switchers, 42.5% switched within 60 days, 50.5% switched to denosumab, and 31.6% switched to oral bisphosphonates. This study of real-world prescribing data found that about half of teriparatide users switched from an antiresorptive agent, and less than half switched to antiresorptive agents after teriparatide discontinuation. Persistence of teriparatide use was suboptimal. In the management of postmenopausal osteoporosis, increasing the persistence of teriparatide use and improving the appropriate treatment sequence of anabolic and antiresorptive drugs are critical to maximizing gains in bone mass, providing the greatest protection against fractures. © 2021 American Society for Bone and Mineral Research (ASBMR).
2020 年美国临床内分泌医师协会（AACE）的绝经后妇女骨质疏松症评估指南将骨质疏松症患者分层为“高”和“极高”骨折风险类别，并建议将合成代谢药物作为初始治疗，然后再使用抗吸收药物。改变这种治疗顺序可能会削弱合成代谢药物的效果，而不使用抗吸收药物则会导致合成代谢药物产生的骨量流失。了解合成代谢药物的实际处方模式将很有帮助。本研究使用 2010-2015 年 Medicare 100%骨质疏松症数据库，评估了 2011 年至 2013 年间开始使用特立帕肽的老年女性患者的患者特征、特立帕肽的开方医生、特立帕肽治疗的持续时间以及特立帕肽停药后的抗吸收药物使用情况。该研究纳入了 14786 例患者。在开始特立帕肽治疗前 1 年，有 30.0%的患者发生过骨折，67.6%的患者接受过双能 X 线吸收法扫描，74.4%的患者被诊断为骨质疏松症，47.9%的患者使用了抗吸收药物（非特立帕肽初治患者）。在发生过骨折的患者中，有 49.4%的患者在骨折后 3 个月内开始使用特立帕肽。有 37%的患者由初级保健医生开具特立帕肽处方，19%的患者由风湿病医生开具，13%的患者由内分泌医生开具，7.0%的患者由矫形外科医生开具。特立帕肽的中位使用时间为 7.2 个月。特立帕肽停药后，有 40.8%的患者改用抗吸收药物（特立帕肽初治患者中为 31.9%，非特立帕肽初治患者中为 50.5%）。在换药者中，有 42.5%的患者在 60 天内换药，50.5%的患者换用地舒单抗，31.6%的患者换用口服双膦酸盐。这项真实世界处方数据研究发现，约一半的特立帕肽使用者从抗吸收药物转换，且不到一半的患者在特立帕肽停药后改用抗吸收药物。特立帕肽的使用持续性不理想。在绝经后骨质疏松症的治疗中，提高特立帕肽的使用持续性并改善合成代谢和抗吸收药物的合理治疗顺序，对于最大限度地增加骨量、最大程度地预防骨折至关重要。 © 2021 美国骨矿研究协会（ASBMR）。
