Study On Medication Compliance,Bone Mineral Density And Influencing Factors In Patients With Bone Mass Abnormality

Objective To assess the therapeutic agent compliance and persistence of patients with bone mass abnormality treated with calcium,vitamin D and/or bisphosphonates.To investigate the interactions of bone mineral density(BMD)and age and gender.To explore the influence factors of compliance,persistence and BMD.Method 360 bone mass abnormality inpatients were selected from the Department of endocrinology of Tianjin Medical University General Hospital within 2015.By checking the medical records and telephone following up,we got the information of patients’ demographic characteristics,laboratory test results,imaging examinations,dual energy X-ray absorptiometry image,therapeutic regimen and duration of medication.The compliance was quantified by the Medication Possession Ratio(MPR),which was defined as the sum of all days of medication supply during a given time.80% was set to discribe the categories of good and poor compliance.The differences between the two groups were compared and multivariate analysis was conducted to explore the influencing factors.The persistence could be expressed as the proportion of the cohort still on medication after a given time since first prescription.Non-persistence was assumed when a treatment gap was longer than 1 month or 3 months.We conducted persistence of calcium,vitamin D and oral bisphosphonates at the cut-off point of 3 months and 6 months respectively,and compared their differences of the agents.During hospitalization,326 patients have undergone dual energy X-ray absorptiometry examination.According to the BMD,we divided patients into two groups of osteoporosis and osteopenia,meanwhile,studied the correlation of biochemical index with BMD.We analyzed the oral glucose tolerance test and BMD of 54 patients with newly diagnosed type 2 diabetes mellitus to study the correlation of insulin with BMD.We investigated three bone turnover makers of 77 patients with T2 DM,Graves Disease,Primary hyperparathyroidism and Primary osteoporosis to find the differences of bone metabolic biochemical index between various primary disease groups.Correlation analysis was conducted to observe the correlation of pituitary gonadotropin with BMD in 83 postmenopausal women.Results Of the 274 cases with integral data,132 cases were in good compliance,accounting for 48.2% and 142 cases were in poor compliance,accounting for 51.8%.Multivariate analysis showed that the disease duration,glucocorticoid using history,pain symptom and smoking history were influencing factors of compliance.Difference in compliance between the Calcium plus vitamin D supplementation group,bisphosphonate group and combined treatment group was statistically significant(P <0.05).The persistence of each agent decreased along with time,and the discontinuation rate was more than 50% at the point of 6 month.The L1-L4,femoral neck,total hip and general BMD of male patients were higher than those of female patients.BMD decreased as the age increased.The highest detection rate of bone mass abnormality was observed at femoral neck.There were significant differences in age,serum albumin,blood urea nitrogen,FSH,LH,and the prevalence of fatty liver within two groups of osteoporosis and osteopenia(P <0.05).Pearson correlation analysis showed L1-l4 BMD was positively correlated with body weight,BMI,UA,E2,was negatively correlated with age,HDL,FSH,LH.Femoral neck BMD was positively correlated with body weight,BMI,serum albumin,E2,was negatively correlated with age,BUN,FSH,LH.Total hip BMD was positively correlated with body weight,BMI,serum albumin,E2,was negatively correlated with age,HDL,BUN,FSH,LH.There were no significant differences in Hb A1c%,FBG,FINS,and LN(HOMA-B)between the osteopenia group and the osteoporosis group(P>0.05).LN(HOMA-IR)of osteoporosis group was lower than that of osteopenia group.Pearson correlation analysis showed that there was a positive correlation between LN(HOMA-IR)and total hip BMD as well as whole body BMD(P<0.05).There were no significant differences in body weight,serum albumin,urinary calcium and urinary phosphorus among T2 DM,GD,primary hyperparathyroidism and primary osteoporosis.CTX and PINP in the GD group were higher than those in the primary hyperparathyroidism group(P<0.05).Pearson correlation analysis showed that there was no correlation between femoral neck BMD and FSH,LH,FSH/LH,FSH/E2(P<0.05)in postmenopausal women,which was positively correlated with E2.Conclusion Compliance and persistence of calcium,vitamin D,bisphosphonates in patients with a bone mass abnormality are not satisfactory.Compliance of patients with long course prolongation is better than that with short prolongation.Glucocorticoid using history and pain symptom may improve the poor compliance,while smoking history may decrease the compliance.BMD decreases with the increase of age and there is a false increase in lumbar spine and general BMD.The femoral neck BMD had the higher sensitivity in the diagnosis of bone mass abnormality.Elevated insulin level may be a protective factor for BMD,while,elevated HDL level may be associated with decreased BMD.Bone turnover is active in GD patients,and thyroid hormone could decrease BMD.Decreased BMD in postmenopausal women is associated with decreased estrogen levels.