Adherence of Bisphosphonate and Decreased Risk of Clinical Vertebral Fracture in Osteoporotic Patients : A Propensity Score Matching Analysis
골다공증 환자에서 비스포스포네이트 약물 순응도에 따른 척추골절 위험 분석: 성향점수 매칭 분석으로
- 주제(키워드) Bisphosphonate , osteoporosis , adherence , nationwide cohort study
- 주제(DDC) 610
- 발행기관 아주대학교
- 지도교수 이윤환
- 발행년도 2023
- 학위수여년월 2023. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000032686
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Purpose: Bisphosphonate is associated with a decreased risk of clinical vertebral fractures due to osteoporosis. However, there are limited studies on how poor compliance with bisphosphonate affects the risk of vertebral fractures in a nationwide cohort. We aimed to evaluate whether adherence to bisphosphonate affects the risk of fracture in osteoporosis patients. Methods: We used the data of the Korean National Health Insurance Service Senior Cohort. A total of 33,315 (medication possession ratio [MPR]: 50) osteoporosis patients were matched using the propensity score matching method: those who received low-dose bisphosphonate and those who received high-dose bisphosphonate. Twenty-two confounding variables, including age, socioeconomic status, medications prescribed, and underlying diseases that may affect the risk of fracture were adjusted for propensity score matching. The risk of vertebral fracture was assessed by Cox proportional hazards regression. Results: Patients with a higher MPR showed a decreased vertebral fracture risk than those with a lower MPR (MPR 50 = hazard ratio [HR]: 0.909, 95% confidence interval [CI]: 0.877–0.942, P < 0.001; MPR 70 = HR: 0.874, 95% CI: 0.838–0.913, P < 0.001; MPR 90 = HR: 0.822, 95% CI: 0.780–0.866, P < 0.001). MPR was associated with a decreased clinical vertebral fracture risk in both groups with or without history of fracture. In the subgroup analysis, MPR was associated with a decreased clinical vertebral fracture risk in women, in all age, with or without T2DM, and with or without hypertension. Conclusion: Higher MPR is associated with a lower clinical vertebral fracture risk. Hazard ratio of MPR 50% was 0.909.
more목차
Ⅰ. Introduction 1
Ⅱ. Definition and treatment of osteoporosis 4
A. Definition and clinical importance of osteoporotic fractures 4
B. Treatment 5
Ⅲ. Current status of osteoporotic fractures at home and abroad and socioeconomic burden 6
Ⅳ. Hypotheses and Objectives of Study 9
Ⅴ. Literature Review 10
Ⅵ. Methods 15
A. Study design 15
B. Data source 15
C. Inclusion and exclusion criteria 15
D. Medication possession ratio (MPR) 18
E. Study outcome and subgroup analysis 18
F. Statistical analysis 18
Ⅶ. Results 20
Ⅶ. Discussion 27
Ⅷ. Conclusion 31
Ⅸ. Reference 32
