LAM KID

[Adherence of Hungarian postmenopausal women with osteoporosis]

LAKATOS Péter, TÓTH Emese, LANG Zsolt, NAGY Bence, SZEKERES László, TAKÁCS István

DECEMBER 10, 2012

LAM KID - 2012;2(04)

[INTRODUCTION - Osteoporosis is defined as a loss of bone tissue and bone mass that leads to a compromised trength and quality of bones and thus to an increased risk of fractures. In many women, menopausal hormonal changes are associated with an increased bone loss. This population has postmenopausal osteoporosis. The essence of osteporosis treatment is the adequate calcium and vitamin D supplementation, which, if needed, might be combined with drug therapy to inhibit the process of bone loss. METHODS - We assessed the adherence to therapy of Hungarian patients and its effect on the risk of bone fractures, using data recorded by the National Health Insurance Fund Administration between 2004 and 2010 (n=223068, mean age: 69.9 years). We performed a statistical analyses of the available data. Medication possession ratio (MPR) for each treatment and the ratio of patients receiving continuous treatment in the study period (for 12, 18 and 24 months) were estimated. Medication persistence was investigated using Kaplan-Meier survival analysis. A multivariate Cox proportional hazard model was used to determine the factors influencing the risk of fracture. RESULTS, CONCLUSION - The results of our study show that medication adherence to treatment is low among Hungarian patients [mean MPR: 57.9%; 95% CI (57.7%- 58.0%) and persistence rate: 32.4%; 95% CI (32.2%-32.6%) in the first year]. These parameters are substantially influenced by the administration route and the frequency of treatments [mean MPR ranged 41.5%- 100% and persistence rates ranged 18.8%- 100% in the first year, differences between subgroups were significant (p<0,05)]. Our compliance as well as persistance studies showed that parenteral administration had more beneficial effects. Confirming our preliminary hypotheses, the improvement of patient compliance significantly reduced fracture risk (good compliance was defined as MPR>80%, which was associated with RR: 0.57, p<0.05 for fracture risk). Further improvement might be achieved by parenteral administration [RR for fracture risk 0.60 compared with non-compliant patients and 0.44 compared with compliant subgroups treated with oral and parenteral medications (p<0.05)].]

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[The authors overview the role of hydro-and balneotherapy in osteology. AsHungary is very rich in thermal-mineralwater, this kind of therapy has a greatimportance in the rehabilitation of locomo-tor diseases. In the past years, an increasingnumber of data have been published aboutthe immunomodulatory, metabolic andanalgesic role of hydro- and balneothera-py. Although balneotherapy’s mechanismof action has not been clarified yet, a num-ber of reviews and metaanalyses havefound that hydro- and balneotherapy havea beneficial effect on locomotor diseases.The majority of these articles - many ofthem written by Hungarian authors - dis-cusses the treatment of arthrosis. Further-more, an increasing amount of data isavailable on calcium supplementation withmineral water. In this paper, we discuss therole of hydro- and balneotherapy in thetherapy of osteological diseases, on thebasis of the available evidence. ]

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