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药物防治糖皮质激素性骨质疏松的规范性及影响因素分析
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          蒋文硕    1， 2＊ ，刘 琛 ，曾 艳 （1.首都医科大学宣武医院药学部，北京 100037；2.首都医科大学药学院，北京
          100069）

          中图分类号  R977.1+1      文献标志码  A      文章编号  1001-0408（2025）08-0991-05
          DOI  10.6039/j.issn.1001-0408.2025.08.18

          摘  要  目的  分析糖皮质激素性骨质疏松（GIOP）防治药物使用的规范性和影响因素。方法  回顾性收集 2022 年 1 月 1 日至
          2023年12月31日于我院诊断为风湿免疫性疾病的需长期使用糖皮质激素的住院患者资料。分析患者的GIOP骨折风险分层及
          防治药物使用情况；采用单因素分析和 Logistic 逐步回归分析筛选影响患者防治药物使用规范性的因素。结果  354 例患者中，
          148例患者（41.81%）的骨折风险为低度，103例患者（29.10%）为中度，103例患者（29.10%）为高度；GIOP防治药物使用排名前3位
          的分别为钙剂（78.81%）、维生素D制剂（74.01%）、抗骨质疏松药物（21.19%）。133例（37.57%）患者规范使用了GIOP防治药物，低
          度骨折风险患者的防治规范率显著高于高度和中度骨折风险患者，且高度骨折风险患者显著高于中度骨折风险患者（P＜0.05）。
          单因素分析结果显示，低度骨折风险是GIOP防治药物使用规范性的保护因素，中度骨折风险、吸烟或饮酒、出现药物不良反应以
          及大专以下文化程度是其危险因素（P＜0.05）。Logistic逐步回归分析结果显示，有低、中度骨折风险，有吸烟或饮酒史，服用抗骨
          质疏松药物后出现不良反应患者的防治规范率较低，而既往1个月就诊三甲医院、使用糖皮质激素时间更长患者的防治规范率较
          高（P＜0.05）。结论  我院GIOP防治药物的使用规范率较低；中、高度骨折风险，吸烟或饮酒史，服用抗骨质疏松药物后出现不良
          反应患者的防治规范率较低，而既往1个月就诊于三甲医院、使用糖皮质激素时间更长患者的防治规范率较高。
          关键词  糖皮质激素；骨质疏松；骨折风险；药物防治；影响因素

          Analysis  of  the  standardization  and  influential  factors  in  the  prevention  and  treatment  of  glucocorticoid-
          induced osteoporosis with drugs
          JIANG Wenshuo ，LIU Chen ，ZENG Yan （1.  Dept.  of  Pharmacy，  Xuanwu  Hospital  of  Capital  Medical
                         1， 2
                                     1
                                                  1
          University，  Beijing  100037，  China；2.  College  of  Pharmacy，  Capital  Medical  University，  Beijing  100069，
          China）
          ABSTRACT   OBJECTIVE To analyze the standardization and influential factors medication use for the prevention and treatment
          of glucocorticoid-induced osteoporosis （GIOP）. METHODS The data of inpatients diagnosed as rheumatic immune diseases in our
          hospital  from  January  1，  2022，  to  December  31，  2023，  who  required  long-term  use  of  glucocorticoids，  were  collected  to  analyze
          the  risk  stratification  for  GIOP-related  fractures  and  the  utilization  of  prevention  and  treatment  drug  in  patients.  Univariate  analysis
          and  Logistic  stepwise  regression  analysis  were  employed  to  screen  the  factors  influencing  the  standardization  of  prevention  and
          treatment  drug  use  in  patients.  RESULTS  Among  354  patients，  148  patients （41.81%）  had  a  low  risk  of  osteoporotic  fractures，
          103 patients （29.10%） had a moderate risk， and 103 patients （29.10%） had a high risk. The top three drugs used in the prevention
          and  treatment  of  GIOP  were  calcium  supplements （78.81%），  vitamin  D  preparations （74.01%），  and  anti-osteoporosis  drugs
         （21.19%）.  A  total  of  133  patients （37.57%）  used  the  drugs  for  GIOP  prevention  and  treatment  in  a  standardized  manner.  The
          standardization rate of prevention and treatment in patients with low fracture risk was significantly higher than those with high and
          moderate  fracture  risk，  and  the  standardization  rate  in  patients  with  high  fracture  risk  was  significantly  higher  than  those  with
          moderate  fracture  risk （P＜0.05）.  Besides，  the  univariate  analysis  showed  that  low  fracture  risk  served  as  a  prevention  factor  for
          the  standardized  use  of  prevention  and  treatment  drugs  for  GIOP，  while  moderate  fracture  risk，  smoking  or  drinking，  the
          occurrence of adverse drug reactions， and having an educational level below junior college were risk factors for the normative use
          of  GIOP  prevention  and  treatment  drug （P＜0.05）.  Logistic  stepwise  regression  analysis  showed  that  patients  with  low  and
          moderate  fracture  risk，  a  history  of  smoking  or  drinking，  and  adverse  drug  reactions  to  anti-osteoporosis  drugs  had  a  lower
          standardization rate of prevention and treatment； patients who visited tertiary hospital for the past month and had a longer duration
          of  glucocorticoid  use  had  a  higher  standardization  rate  of  prevention  and  treatment （P＜0.05）.  CONCLUSIONS  The  standardized
                                                             rate  of  prevention  and  treatment  drugs  used  for  GIOP  in  our
                                                             hospital  is  relatively  low.  Patients  with  moderate  to  high
             Δ 基金项目 医疗质量（循证）管理研究项目（No.YLZLXZ24-
          K010）                                              fracture risk， a history of smoking or drinking， and those who
             ＊ 第一作者 硕 士 研 究 生 。 研 究 方 向 ：临 床 药 学 。 E-mail：   experience  adverse  drug  reactions  after  taking  anti-osteoporosis
          j3011760546@163.com                                drugs  have  lower  rates  of  standardized  prevention  and
             # 通信作者 主任药师，硕士。研究方向：临床药学。E-mail：                treatment.  Conversely，  patients  who  sought  treatment  at
          zengyan@xwhosp.org                                 tertiary  hospital  for  the  past  month  and  had  a  longer  duration


          中国药房  2025年第36卷第8期                                                 China Pharmacy  2025 Vol. 36  No. 8    · 991 ·
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