Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, T2T 5C7, Canada.
Department of Medicine, McGill University, Montreal, H4A 3J1, Canada.
J Clin Endocrinol Metab. 2022 Jan 18;107(2):491-499. doi: 10.1210/clinem/dgab696.
Fracture on therapy should motivate better antifracture medication adherence.
This study aimed to describe osteoporosis medication adherence in women before and following a fracture.
This retrospective cohort analysis of antifracture medication possession ratios (MPR) among women in the Manitoba BMD Registry (1996-2013) included menopausal women who started antifracture drug therapy after a dual-energy x-ray absorptiometry (DXA)-BMD assessment with follow-up for 5 years during which a nontraumatic fracture occurred at least 1 year after starting treatment. Linked prescription records determined medication adherence (estimated by MPR) in 1-year intervals. The variable of interest was MPR in the year before and after the year in which the fracture occurred, with subgroup analyses according to duration of treatment pre-fracture. We chose an MPR of ≥ 0.50 to indicate minimum adherence needed for drug efficacy.
There were 585 women with fracture on therapy, 193 (33%) had hip or vertebral fracture. Bisphosphonates accounted for 82.2% of therapies. Median MPR the year prior to fracture was 0.89 (IQR, 0.49-1.0) and 0.69 (IQR, 0.07-0.96) the year following the year of fracture (P < 0.0001). The percentage of women with MPR ≥ 0.5 pre-fracture was 73.8%, dropping to 57.3% post-fracture (P < 0.0001); when restricted to hip/vertebral fracture, results were similar (58.2% to 33.3%; P < 0.002). Among those with pre-fracture MPR < 0.5, only 21.7% achieved a post-fracture MPR ≥ 0.5.
Although fracture on therapy may motivate sustained/improved adherence, MPR remains low or even declines after fracture in many. This could reflect natural decline in MPR with time but is paradoxical to expectations. Fracture on therapy represents an important opportunity for clinicians to reemphasize treatment adherence.
治疗过程中发生骨折应促使更好地坚持抗骨折药物治疗。
本研究旨在描述骨折后女性骨质疏松症药物治疗的依从性。
本项对马尼托巴省骨密度登记处（1996-2013 年）中抗骨折药物治疗开始后发生骨折的绝经后妇女进行回顾性队列分析，纳入在双能 X 射线吸收法（DXA）-骨密度评估后开始抗骨折药物治疗、在开始治疗至少 1 年后发生非外伤性骨折且在 5 年内有随访的患者。通过链接的处方记录，在 1 年的间隔内确定药物的依从性（通过 MPR 估计）。研究的变量是骨折发生前一年和后一年的 MPR，亚组分析根据骨折前治疗的持续时间。我们选择 MPR ≥ 0.50 表示药物疗效所需的最低依从性。
共有 585 名骨折患者正在接受治疗，其中 193 名（33%）患有髋部或脊柱骨折。双磷酸盐占治疗方法的 82.2%。骨折前一年的 MPR 中位数为 0.89（IQR，0.49-1.0），骨折后一年为 0.69（IQR，0.07-0.96）（P<0.0001）。骨折前 MPR≥0.5 的女性百分比为 73.8%，骨折后降至 57.3%（P<0.0001）；当仅限于髋部/脊柱骨折时，结果相似（58.2%降至 33.3%；P<0.002）。在骨折前 MPR<0.5 的患者中，只有 21.7%在骨折后达到 MPR≥0.5。
尽管骨折治疗过程中可能会促使患者坚持/改善治疗，但许多患者在骨折后 MPR 仍然较低甚至下降。这可能反映了 MPR 随时间自然下降，但与预期相悖。骨折治疗为临床医生提供了一个重要机会，可以再次强调治疗的依从性。
