Osteoporosis Medication and Reduced Mortality Risk in Elderly Women and Men
Osteoporosis Medication and Reduced Mortality Risk in Elderly Women and Men
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DOI：
10.1210/jc.2010-2730
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发表时间：
2011-04-01
影响因子：
5.8
通讯作者：
Eisman, John A.
中科院分区：
文献类型：
--
作者：
Center, Jacqueline R.;Bliuc, Dana;Eisman, John A.
背景：骨质疏松性骨折与过早死亡有关。抗骨吸收治疗可减少再骨折，但死亡率的降低尚不清楚。目的：本研究的目的是检查骨质疏松症治疗[双膦酸盐（BP），激素治疗（HT）和钙+/-维生素D（CaD）]对死亡风险的影响。设计：这是一项前瞻性队列研究研究对象：社区老年人，1989年4月至2007年5月（年龄60岁以上）受试者在杜博，一个半城市化的城市，澳大利亚。受试者包括杜博骨质疏松流行病学研究中的1223名女性和819名男性。主要结果测量：根据治疗组记录死亡率。（BP，n = 106; HT，n = 77; CaD，n = 142）女性和37名男性（BP，n = 15; CaD，n = 22）接受治疗。在女性中，BP组死亡率为0.8/100人-年（0.4，1.4），HT组为1.2/100人-年（0.7，2.1），但CaD组为3.2/100人-年（2.5，4.1），而未治疗组为3.5/100人-年（3.1，3.8）。考虑到年龄、骨折发生率、合并症、股四头肌强度和骨密度，BP组女性的死亡风险仍然较低[风险比（HR）0.3（0.2，0.6）]，但HT组女性的死亡风险不低[HR 0.8（0.4，1.8）]。对于429例骨折女性，BP组的死亡风险仍然降低[校正HR 0.3（0.2，0.7）]，但未考虑后续骨折的减少。在男性中，观察到BP而非CaD的死亡率较低[BP 1.0/100人-年（0.3，3.9）和CaD 3.1/100人-年（1.5，6.6）vs.未治疗4.3/100人-年（3.9，4.8）]。校正后，死亡率相似，但不显著[HR 0.5（0.1，2.0）]。结论：骨质疏松症治疗似乎降低了女性和男性的死亡风险。（临床内分泌代谢杂志96：1006-1014，2011）
Context: Osteoporotic fractures are associated with premature mortality. Antiresorptive treatment reduces refracture but mortality reduction is unclear.Objective: The objective of the study was to examine the effect of osteoporosis treatment [bis-phosphonates (BP), hormone therapy (HT), and calcium +/- vitamin D only (CaD)] on mortality risk.Design: This was a prospective cohort study (April 1989 to May 2007).Setting: The study was conducted with community-dwelling elderly (aged 60+ yr) subjects in Dubbo, a semiurban city, Australia.Subjects: Subjects included 1223 and 819 women and men in the Dubbo Osteoporosis Epidemiology Study.Main Outcome Measure: Mortality according to treatment group was recorded.Results: There were 325 (BP, n = 106; HT, n = 77; CaD, n = 142) women and 37 men (BP, n = 15; CaD, n = 22) on treatment. In women, mortality rates were lower with BP 0.8/100 person-years (0.4, 1.4) and HT 1.2/100 person-years (0.7, 2.1) but not CaD 3.2/100 person-years (2.5, 4.1) vs. no treatment 3.5/100 person-years (3.1, 3.8). Accounting for age, fracture occurrence, comorbidities, quadriceps strength, and bone mineral density, mortality risk remained lower for women on BP [hazard ratio (HR) 0.3 (0.2, 0.6)] but not HT [HR 0.8 (0.4, 1.8)]. For 429 women with fractures, mortality risk was still reduced in the BP group [adjusted HR 0.3 (0.2, 0.7)], not accounted for by a reduction in subsequent fractures. In men, lower mortality rates were observed with BP but not CaD [BP 1.0/100 person-years (0.3, 3.9) and CaD 3.1/100 person-years (1.5, 6.6) vs. no treatment 4.3/100 person-years (3.9, 4.8)]. After adjustment, mortality was similar, although not significant [HR 0.5 (0.1, 2.0)].Conclusions: Osteoporosis therapy appears to reduce mortality risk in women and possibly men. (J Clin Endocrinol Metab 96: 1006-1014, 2011)