Atopic Eczema-Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study.
Atopic Eczema-Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study.
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DOI：
10.1016/j.jaip.2021.09.026
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Langan SM
中科院分区：
文献类型：
--
作者：
Matthewman J;Mansfield KE;Prieto-Alhambra D;Mulick AR;Smeeth L;Lowe KE;Silverwood RJ;Langan SM
有证据表明患有特应性湿疹的成年人骨折风险增加。然而，尚不清楚口服皮质类固醇是否可以解释这种关联。评估口服皮质类固醇在多大程度上介导特应性湿疹和骨折之间的关系。我们使用英国初级保健（临床实践研究数据链接）和入院（医院发作统计）记录（1998-2016）进行了一项队列研究，其中包括患有特应性湿疹的成年人（18岁以上），与最多五名没有特应性湿疹的成年人进行匹配（年龄、性别和一般实践）。我们使用 Cox 回归来估计特定主要骨质疏松性骨折（髋部、脊柱、骨盆、手腕）和任何部位骨折的风险比 (HR)，将患有特应性湿疹的个体与没有特应性湿疹的个体进行比较，并根据时间更新的口服皮质类固醇使用的六种不同定义（任何处方、曾经的高剂量以及最近、累积、当前或峰值剂量）进行调整。我们确定了 526,808 名患有特应性湿疹的人，以及 2,569,030 名没有特应性湿疹的人。我们发现特应性湿疹与主要骨质疏松性骨折之间存在关联的证据（例如，脊柱 HR 1.15 99%CI 1.08–1.22；髋部 HR 1.11 99%CI 1.08–1.15），在额外调整口服皮质类固醇后仍然存在这种关联（例如累积皮质类固醇剂量：脊柱 HR 1.09 99%CI） 1.03–1.16；髋部 HR 1.09 99%CI 1.06–1.12）。即使在调整口服皮质类固醇后，患有严重特应性湿疹的人的骨折率也比没有患严重特应性湿疹的人更高（例如，脊柱 HR [99% CI]：混杂因素调整 2.31 [1.91–2.81]；另外调整累积剂量 1.71 [1.40–2.09]）。我们的研究结果表明，特应性湿疹和主要骨质疏松性骨折之间的关联几乎不能通过口服皮质类固醇的使用来解释。
Evidence suggests adults with atopic eczema have increased fracture risk. However, it is unclear whether oral corticosteroids explain the association. To assess to what extent oral corticosteroids mediate the relationship between atopic eczema and fractures. We conducted a cohort study using English primary care (Clinical Practice Research Datalink) and hospital admissions (Hospital Episode Statistics) records (1998-2016) including adults (18+) with atopic eczema matched (age, sex, and general practice) with up to five adults without atopic eczema. We used Cox regression to estimate hazard ratios (HRs) for specific major osteoporotic fractures (hip, spine, pelvis, wrist) and for any-site fracture comparing individuals with atopic eczema to those without, adjusting for six different definitions of time-updated oral corticosteroid use (ever any prescription, ever high dose, and recent, cumulative, current or peak dose). We identified 526,808 individuals with atopic eczema and 2,569,030 without. We saw evidence of an association between atopic eczema and major osteoporotic fractures (e.g., spine HR 1.15 99%CI 1.08–1.22; hip HR 1.11 99%CI 1.08–1.15) that remained after additionally adjusting for oral corticosteroids (e.g., cumulative corticosteroid dose: spine HR 1.09 99%CI 1.03–1.16; hip HR 1.09 99%CI 1.06–1.12). Fracture rates were higher in people with severe atopic eczema compared to people without even after adjusting for oral corticosteroids (e.g., spine HR [99%CI]: confounder adjusted 2.31 [1.91–2.81]; additionally adjusted for cumulative dose 1.71 [1.40–2.09]). Our findings suggest that little of the association between atopic eczema and major osteoporotic fractures is explained by oral corticosteroid use.
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影响因子：
6.2
作者：
Delmas, PD;van de Langerijt, L;Cahall, DL
通讯作者：
Cahall, DL
影响因子：
1.2
作者：
Hatgis, Jesse;Granville, Michelle;Jacobson, Robert E.
通讯作者：
Jacobson, Robert E.
影响因子：
10.9
作者：
Egeberg, Alexander;Schwarz, Peter;Thyssen, Jacob P.
通讯作者：
Thyssen, Jacob P.
影响因子：
6.5
作者：
Abuabara, Katrina;Magyari, Alexa M.;Langan, Sinead M.
通讯作者：
Langan, Sinead M.
DOI：
10.1002/jbmr.1476
发表时间：
2012-03
期刊：
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
影响因子：
--
作者：
Gehlbach S;Saag KG;Adachi JD;Hooven FH;Flahive J;Boonen S;Chapurlat RD;Compston JE;Cooper C;Díez-Perez A;Greenspan SL;LaCroix AZ;Netelenbos JC;Pfeilschifter J;Rossini M;Roux C;Sambrook PN;Silverman S;Siris ES;Watts NB;Lindsay R
通讯作者：
Lindsay R