Malacon Karen, Beach Isidora, Touponse Gavin, Rangwalla Taiyeb, Lee Jennifer, Zygourakis Corinna
School of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA.
Department of Neurosurgery, Larner College of Medicine at The University of Vermont, Burlington, VT 05405, USA.
J Endocr Soc. 2023 Jun 20;7(7):bvad085. doi: 10.1210/jendso/bvad085. eCollection 2023 Jun 5.
Osteoporosis affects more than 200 million individuals worldwide and predisposes to vertebral compression fractures (VCFs). Given undertreatment of fragility fractures, including VCFs, we investigate current anti-osteoporotic medication prescribing trends.
Patients 50 and older with a diagnosis of primary closed thoracolumbar VCF between 2004 and 2019 were identified from the Clinformatics® Data Mart database. Multivariate analysis was performed for demographic and clinical treatment and outcome variables.
Of 143 081 patients with primary VCFs, 16 780 (11.7%) were started on anti-osteoporotic medication within a year; 126 301 (88.3%) patients were not started on medication. The medication cohort was older (75.4 ± 9.3 vs 74.0 ± 12.3 years, < .001), had higher Elixhauser Comorbidity Index scores (4.7 ± 6.2 vs 4.3 ± 6.7, < .001), was more likely to be female (81.1% vs 64.4%, < .001), and was more likely to have a formal osteoporosis diagnosis (47.8% vs 32.9%) than the group that did not receive medication. Alendronate (63.4%) and calcitonin (27.8%) were the most commonly initiated medications. The proportion of individuals receiving anti-osteoporotic medication within the year following VCF peaked in 2008 (15.2%), then declined until 2012 with a modest increase afterward.
Osteoporosis remains undertreated after low-energy VCFs. New anti-osteoporotic medication classes have been approved in recent years. Bisphosphonates remain the most prescribed class. Increasing recognition and treatment of osteoporosis is paramount to decreasing the risk of subsequent fractures.
骨质疏松症影响着全球超过2亿人，并易导致椎体压缩性骨折（VCF）。鉴于脆性骨折（包括VCF）的治疗不足，我们调查了当前抗骨质疏松药物的处方趋势。
从Clinformatics®数据集市数据库中识别出2004年至2019年间诊断为原发性闭合性胸腰椎VCF的50岁及以上患者。对人口统计学、临床治疗和结局变量进行多变量分析。
在143081例原发性VCF患者中，16780例（11.7%）在一年内开始使用抗骨质疏松药物；126301例（88.3%）患者未开始用药。用药队列年龄更大（75.4±9.3岁对74.0±12.3岁，P<.001），埃利克斯豪泽合并症指数得分更高（4.7±6.2对4.3±6.7，P<.001），女性比例更高（81.1%对64.4%，P<.001），并且比未接受药物治疗的组更有可能有正式的骨质疏松症诊断（47.8%对32.9%）。阿仑膦酸盐（63.4%）和降钙素（27.8%）是最常用的起始药物。VCF后一年内接受抗骨质疏松药物治疗的个体比例在2008年达到峰值（15.2%），然后下降至2012年，之后略有上升。
低能量VCF后骨质疏松症的治疗仍然不足。近年来已批准了新的抗骨质疏松药物类别。双膦酸盐仍然是处方最多的类别。提高对骨质疏松症的认识和治疗对于降低后续骨折的风险至关重要。
