Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan; National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
Bone. 2022 Jul;160:116396. doi: 10.1016/j.bone.2022.116396. Epub 2022 Mar 26.
Early initiation of anti-osteoporosis medications (AOMs) is recommended for patients on long-term glucocorticoid (GC) therapy. This study aimed to examine whether physicians prescribe AOMs as soon as GC therapy is initiated, and whether a delay in AOM initiation affects hip and vertebral fracture incidence, using the nationwide health insurance claims database of Japan (NDBJ).
Patients aged ≥50 years who were prescribed GC (≥5 mg/day prednisolone or equivalent) for ≥90 days and who were followed for AOM use and hip and vertebral fracture events for the subsequent 1080 days in 2012-2018 were selected from NDBJ. Delay in AOM initiation was defined as the number of days without AOMs following GC therapy initiation. Associations between delay in AOM initiation and hip and vertebral fracture risk were evaluated by Cox proportional hazards regression.
In total, 92,143 women and 94,772 men were included in the analysis, of which only 39.3% of women and 28.5% of men received AOMs within 90 days from GC therapy initiation. Approximately, 15% of hip fractures and 30% of vertebral fractures occurred before AOM initiation in patients with delayed AOM initiation. HRs of both fractures were significantly greater in patients with a longer delay in AOM initiation (p value for trend<0.001). After excluding patients who had fractures before AOM initiation, the magnitude of HRs significantly decreased, and HR trends for hip fracture became insignificant.
Delayed initiation of AOMs may result in increased fracture events, which may be reduced by early initiation of AOMs.
对于长期接受糖皮质激素（GC）治疗的患者，建议早期开始使用抗骨质疏松药物（AOM）。本研究旨在利用日本全国医疗保险索赔数据库（NDBJ），检验 GC 治疗开始后医生是否尽快开具 AOM 处方，以及 AOM 起始延迟是否会影响髋部和椎体骨折的发生率。
从 NDBJ 中选择 2012-2018 年期间年龄≥50 岁、接受 GC（≥5mg/天泼尼松龙或等效药物）治疗≥90 天且在随后的 1080 天内随访 AOM 使用和髋部及椎体骨折事件的患者。AOM 起始延迟定义为 GC 治疗开始后无 AOM 的天数。通过 Cox 比例风险回归评估 AOM 起始延迟与髋部和椎体骨折风险之间的关联。
共纳入 92143 名女性和 94772 名男性，其中仅 39.3%的女性和 28.5%的男性在 GC 治疗开始后 90 天内使用 AOM。在 AOM 起始延迟的患者中，约 15%的髋部骨折和 30%的椎体骨折发生在 AOM 起始之前。AOM 起始延迟时间越长，骨折的 HR 越高（趋势检验 p 值<0.001）。在排除 AOM 起始前发生骨折的患者后，HR 显著降低，髋部骨折的 HR 趋势变得无统计学意义。
AOM 起始延迟可能导致骨折事件增加，早期起始 AOM 可能会减少这些事件的发生。
