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双膦酸盐类用药后的非典型股骨骨折风险与脆性骨折预防作用的比较
Bisphosphonates — Atypical Femur Fracture Risk versus Fracture Benefits


Dennis M. Black ... 其他 • 2020.08.20
相关阅读
• 权衡双膦酸盐类药物对骨质疏松性骨折的预防作用和非典型股骨骨折的风险 • 髋部骨折发病率下降的原因是什么 • 更长时间的双膦酸盐治疗并不一定产生更好的治疗效果

摘要


背景

双膦酸盐类药物可有效减少髋部骨折和骨质疏松性骨折。然而,对非典型股骨骨折的担心使双膦酸盐类药物的使用显著减少,而髋部骨折的发生率可能在增加。关于非典型股骨骨折与双膦酸盐类药物和其他危险因素之间的关联,目前仍有重要的不确定性。

 

方法

我们研究了美国凯泽永久医疗集团南加利福尼亚公司(Kaiser Permanente Southern California)医疗系统中正在接受双膦酸盐类药物治疗的≥50岁女性;并在2007年1月1日至2017年11月30日对其进行了随访。主要结局是非典型股骨骨折。我们从电子病历获得了关于危险因素(包括双膦酸盐类药物用药)的数据,通过影像学检查判定骨折,并使用了多变量Cox模型。我们为双膦酸盐类药物用药1~10年建立了风险-获益特征模型,从而比较相关非典型骨折和预防的其他骨折。

 

结果

196,129名女性发生了277例非典型股骨骨折。经过多变量校正后,非典型骨折风险随着双膦酸盐类药物用药时间的延长而增加:我们确定了长时间用药与用药不到3个月相比较的风险比,这一数值从用药3年~<5年的8.86(95%置信区间[CI],2.79~28.20)增加至用药≥8年的43.51(95% CI,13.70~138.15)。其他危险因素包括人种(亚裔 vs. 白种人的风险比,4.84;95% CI,3.57~6.56)、身高、体重和糖皮质激素用药。双膦酸盐类药物停药与非典型骨折风险迅速降低相关。在白种人中,双膦酸盐类药物用药1~10年期间的骨质疏松性骨折和髋部骨折风险降幅远超过非典型骨折的风险升幅,但亚裔中的上述差距较小。用药3年后,白种人预防了149例髋部骨折,发生了2例双膦酸盐类药物相关性非典型骨折,而亚裔的这两个数值分别为91例和8例。

 

结论

非典型股骨骨折风险随着双膦酸盐类药物用药时间的延长而增加,并且在双膦酸盐类药物停药后迅速降低。亚裔的风险高于白种人。相对于双膦酸盐类药物用药后髋部骨折和其他骨折的风险降幅而言,非典型股骨骨折的绝对风险仍然很低(由美国凯泽永久医疗集团[Kaiser Permanente]等资助)。





作者信息

Dennis M. Black, Ph.D., Erik J. Geiger, M.D., Richard Eastell, M.D., Eric Vittinghoff, Ph.D., Bonnie H. Li, M.S., Denison S. Ryan, M.P.H., Richard M. Dell, M.D., and Annette L. Adams, Ph.D.
From the Departments of Epidemiology and Biostatistics (D.M.B., E.V.) and Orthopedic Surgery (E.J.G.), University of California, San Francisco, San Francisco, the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (D.M.B., B.H.L., D.S.R., A.L.A.), and the Department of Orthopedics, Kaiser Permanente Southern California, Downey (R.M.D.) — all in California; and the Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom (R.E.). Address reprint requests to Dr. Black at the Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St., Box 0560, San Francisco, CA 94143, or at dennis.black@ucsf.edu.

 

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