Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis
| Autor: | James Bradley Layton, MA Brookhart, Margaret L. Gourlay, Joel F. Farley, Robert A. Overman, Chad L. Deal |
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| Předmět: |
medicine.medical_specialty
Endocrinology Diabetes and Metabolism Osteoporosis Administration Oral Drug Administration Schedule Article Internal medicine otorhinolaryngologic diseases medicine Humans In patient Glucocorticoids Osteoporosis Postmenopausal Aged Retrospective Studies Aged 80 and over Bone Density Conservation Agents business.industry Retrospective cohort study Middle Aged medicine.disease Rheumatology Surgery Orthopedic surgery Anti osteoporosis Female business Osteoporotic Fractures Glucocorticoid Follow-Up Studies medicine.drug |
| Zdroj: | Europe PubMed Central |
| Popis: | Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95% confidence intervals (95% CI) were estimated using weighted Cox proportional hazard models.Of the 7885 women eligible for the study, 12.1% were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95% CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95% CI 0.47, 0.99) at 3 years.AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48% at 1 year and 32% at 3 years. |
| Databáze: | OpenAIRE |
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