Duration of Bisphosphonate Drug Holidays and Associated Fracture Risk.
Duration of Bisphosphonate Drug Holidays and Associated Fracture Risk.
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DOI：
10.1097/mlr.0000000000001294
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发表时间：
2020-05
期刊：
影响因子：
3
通讯作者：
Delzell E
中科院分区：
文献类型：
--
作者：
Curtis JR;Saag KG;Arora T;Wright NC;Yun H;Daigle S;Matthews R;Delzell E
双膦酸盐（BP）或“药物假期”治疗数年后停药越来越常见。然而，药物假期持续时间与未来骨折风险的关系尚不清楚。我们评估了接受长期BP治疗的女性中骨折发生率与不同休药期长度的关系。使用2006-2016年美国医疗保险数据的观察性队列研究。使用发生率（IR）和考克斯比例风险模型评价发生率和校正风险比（aHR），控制潜在混杂因素。参加按服务付费医疗保险的65岁及以上女性，坚持（≥ 80%）使用阿仑膦酸钠、利塞膦酸钠或唑来膦酸钠≥ 3年。髋关节、肱骨、前臂远端和临床椎骨骨折。在81，427名合格女性中，观察中位数（四分位距）为4.0（2.5，5.3）年，28%的女性经历了药物假期。在阿仑膦酸钠队列（总体73%）中，停用BP> 2年的女性髋部骨折的IR为13.2/1000人-年。风险增加（aHR =1.3，1.1-1.4）与继续治疗（IR =8.8，参照）。停药>2年的肱骨骨折（aHR =1.3，1.1-1.66）和停药> 2年的临床椎骨骨折（aHR =1.2，1.1-1.4）的发生率升高。利塞膦酸盐、唑来膦酸盐和伊班膦酸盐治疗髋部骨折和临床椎体骨折的结果相似。停用阿仑膦酸钠超过2年与髋关节、肱骨和临床椎骨骨折的风险增加相关。
Discontinuation of bisphosphonates (BP) or a “drug holiday” after several years of treatment is increasingly common. However, the association of drug holiday duration with future fracture risk is unclear. We evaluated the rate of fracture in relation to various lengths of drug holidays among women receiving long-term BP therapy. Observational cohort study using US Medicare data 2006–2016. Incidence rates (IRs) and Cox proportional hazards models were used to evaluate the rate and adjusted hazard ratios (aHRs) controlling for potential confounders. Women aged 65 years and above enrolled in fee-for-service Medicare who had been adherent (≥ 80%) to alendronate, risedronate, or zoledronate for ≥ 3 years. Hip, humerus, distal forearm, and clinical vertebral fracture. Among 81,427 eligible women observed for a median (interquartile range) of 4.0 (2.5, 5.3) years, 28% of women underwent a drug holiday. In the alendronate cohort (73% overall), the IR of hip fracture among women who discontinued BP for > 2 years was 13.2 per 1000 person-years. Risk was increased (aHR =1.3, 1.1–1.4) versus continuing therapy (IR =8.8, referent). Rates were elevated for humerus fracture with discontinuation >2 years (aHR =1.3, 1.1–1.66) and for clinical vertebral fracture with discontinuation > 2 years (aHR =1.2, 1.1–1.4). Results were similar for risedronate, zoledronate, and ibandronate for hip and clinical vertebral fracture. Discontinuing alendronate beyond 2 years was associated with increased risk of hip, humerus, and clinical vertebral fractures.