PDF(Pubmed)
Abstract：
UNASSIGNED: Noncommunicable, chronic diseases need pharmacological interventions for long periods or even throughout life. The temporary or permanent cessation of medication for a specific period, known as a \'medication holiday,\' should be planned by healthcare professionals.
UNASSIGNED: We evaluated the association between continuity (adherence or persistence) of treatment and several outcomes in patients with fragility fractures in the context of the development of the Italian Guidelines.
UNASSIGNED: Systematic review.
UNASSIGNED: We systematically searched PubMed, Embase, and the Cochrane Library up to November 2020 for randomized clinical trials (RCTs) and observational studies that analyzed medication holidays in patients with fragility fracture. Three authors independently extracted data and appraised the risk of bias of the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random effects models. Primary outcomes were refracture and quality of life; secondary outcomes were mortality and treatment-related adverse events.
UNASSIGNED: Six RCTs and nine observational studies met our inclusion criteria, ranging from very low to moderate quality. The adherence to antiosteoporotic drugs was associated with a lower risk of nonvertebral fracture [relative risk (RR) 0.42, 95% confidence interval (CI) 0.20-0.87; three studies] than nonadherence, whereas no difference was detected in the health-related quality of life. A reduction in refracture risk was observed when continuous treatment was compared to discontinuous therapy (RR 0.49, 95% CI 0.25-0.98; three studies). A lower mortality rate was detected for the adherence and persistence measures, while no significant differences were noted in gastrointestinal side effects in individuals undergoing continuous versus discontinuous treatment.
UNASSIGNED: Our findings suggest that clinicians should promote adherence and persistence to antiosteoporotic treatment in patients with fragility fractures unless serious adverse effects occur.
UNASSIGNED: We evaluated the association between continuity (adherence or persistence) of treatment and several outcomes in patients with fragility fractures in the context of the development of the Italian Guidelines.
UNASSIGNED: Systematic review.
UNASSIGNED: We systematically searched PubMed, Embase, and the Cochrane Library up to November 2020 for randomized clinical trials (RCTs) and observational studies that analyzed medication holidays in patients with fragility fracture. Three authors independently extracted data and appraised the risk of bias of the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random effects models. Primary outcomes were refracture and quality of life; secondary outcomes were mortality and treatment-related adverse events.
UNASSIGNED: Six RCTs and nine observational studies met our inclusion criteria, ranging from very low to moderate quality. The adherence to antiosteoporotic drugs was associated with a lower risk of nonvertebral fracture [relative risk (RR) 0.42, 95% confidence interval (CI) 0.20-0.87; three studies] than nonadherence, whereas no difference was detected in the health-related quality of life. A reduction in refracture risk was observed when continuous treatment was compared to discontinuous therapy (RR 0.49, 95% CI 0.25-0.98; three studies). A lower mortality rate was detected for the adherence and persistence measures, while no significant differences were noted in gastrointestinal side effects in individuals undergoing continuous versus discontinuous treatment.
UNASSIGNED: Our findings suggest that clinicians should promote adherence and persistence to antiosteoporotic treatment in patients with fragility fractures unless serious adverse effects occur.
摘要：
■非通信，慢性疾病需要长期甚至终生的药物干预。在特定时期暂时或永久停止药物治疗，被称为“药物假期”，\'应由医疗保健专业人员计划。
我们在制定《意大利指南》的背景下，评估了脆性骨折患者治疗的连续性（依从性或持久性）与多种结局之间的关系。
■系统评价。
■我们系统地搜索了PubMed，Embase,和Cochrane图书馆截至2020年11月进行随机临床试验（RCT）和观察性研究，分析脆性骨折患者的药物假期。三位作者独立提取了数据，并评估了纳入研究的偏倚风险。使用建议分级评估来评估证据质量，开发和评估方法。使用随机效应模型在荟萃分析中汇集效应大小。主要结局为再骨折和生活质量；次要结局为死亡率和治疗相关不良事件。
■6项RCT和9项观察性研究符合我们的纳入标准，从非常低到中等质量。抗骨质疏松药物的依从性与非椎骨骨折的风险[相对风险（RR）0.42，95％置信区间（CI）0.20-0.87;三项研究]与非依从性相比，而与健康相关的生活质量没有检测到差异。连续治疗与不连续治疗相比，观察到再骨折风险降低（RR0.49，95％CI0.25-0.98；三项研究）。坚持和坚持措施的死亡率较低，而在接受连续和不连续治疗的个体中，胃肠道副作用没有显着差异。
■我们的研究结果表明，除非发生严重的不良反应，否则临床医生应提高脆性骨折患者抗骨质疏松治疗的依从性和持久性。
我们在制定《意大利指南》的背景下，评估了脆性骨折患者治疗的连续性（依从性或持久性）与多种结局之间的关系。
■系统评价。
■我们系统地搜索了PubMed，Embase,和Cochrane图书馆截至2020年11月进行随机临床试验（RCT）和观察性研究，分析脆性骨折患者的药物假期。三位作者独立提取了数据，并评估了纳入研究的偏倚风险。使用建议分级评估来评估证据质量，开发和评估方法。使用随机效应模型在荟萃分析中汇集效应大小。主要结局为再骨折和生活质量；次要结局为死亡率和治疗相关不良事件。
■6项RCT和9项观察性研究符合我们的纳入标准，从非常低到中等质量。抗骨质疏松药物的依从性与非椎骨骨折的风险[相对风险（RR）0.42，95％置信区间（CI）0.20-0.87;三项研究]与非依从性相比，而与健康相关的生活质量没有检测到差异。连续治疗与不连续治疗相比，观察到再骨折风险降低（RR0.49，95％CI0.25-0.98；三项研究）。坚持和坚持措施的死亡率较低，而在接受连续和不连续治疗的个体中，胃肠道副作用没有显着差异。
■我们的研究结果表明，除非发生严重的不良反应，否则临床医生应提高脆性骨折患者抗骨质疏松治疗的依从性和持久性。
