OSTEOPOROTİK GERİATRİK HASTALARDA İNTRAVENÖZ ZOLEDRONİK ASİT TEDAVİSİNE CEVAPTA KOMORBİDİTE, İLAÇ VE KIRILGANLIK ETKİSİ
Özet
The effects of drugs, multimorbidity and frailty on the osteoporosis treatment response is a rarely studied area, and frail older adults are often excluded from these studies in this area, as in other areas. In this study, it was aimed to investigate the effects of chronic diseases, polypharmacy, frailty, and comprehensive geriatric assessment components on the success of osteoporosis treatment. Another aim was to determine the factors that reduce the effectiveness of the treatment.
The study included 156 patients who received osteoporosis treatment (zoledronic acid) for the first time among osteoporotic patients admitted to Hacettepe University Faculty of Medicine, Department of Internal Medicine, Department of Geriatric Medicine outpatient clinic between 01 September 2010 and 31 May 2021. Information about the patients was obtained retrospectively from the hospital automation system. Bone mineral density (BMD) and T score changes in the patients' total lumbar (L1-4), femoral neck and total femur regions after treatment, and compression and other fragility fractures during the follow-up period were evaluated. In accordance with the recommendations of the International Society of Clinical Densitometry (ISCD), the presence of 2 or more fractures after treatment or a decrease in BMD greater than the least significant change was considered as treatment failure. Patients were followed up for a median of 14.4 months (IQR=11.9-20.8) from zoledronic acid infusion to control BMD measurement. While 76% (n=119) of the patients were female, the median age was 75.0 years (IQR=71.0-80.0). There were 46 (29.5%) patients with treatment failure.
After treatment, new vertebral compression fractures, total fragility fractures (including vertebral compression fractures), and falls were statistically significantly rarer (p=0.004; p=0.023; p<0.001; respectively). Treatment response was decreased in illiterate patients (p=0.036) and patients with 3 or more chronic diseases (p=0.001), higher Charlson’s comorbidity index (p=0.004), hyperthyroidism (p=0.003), insulin use (p=0.003), and older age (p=0.013).
Results of binary logistic regression analyzes revealed that having 3 or more chronic diseases (OR:3.2, 95% CI=1.26-8.09, p=0.01) and the CFS score ≥5 (OR:2.36, %95 GA=1.06-5.36, p=0.04) independently decreased the treatment response. It has been observed that using insulin (OR:3.82, %95 GA=1.36-10.75, p=0.01) and being older (OR:1.1, %95 GA=1.03-1.18, p=0.004) cause a decrease in treatment success when only BMD is evaluated without considering fractures.
