A review of the methods used to define glucocorticoid exposure and risk attribution when investigating the risk of fracture in a rheumatoid arthritis population.
A review of the methods used to define glucocorticoid exposure and risk attribution when investigating the risk of fracture in a rheumatoid arthritis population.
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DOI：
10.1016/j.bone.2016.06.001
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发表时间：
2016-09
期刊：
影响因子：
4.1
通讯作者：
Dixon WG
中科院分区：
文献类型：
--
作者：
Robinson DE;Dennison EM;Cooper C;van Staa TP;Dixon WG
糖皮质激素治疗类风湿关节炎（RA）疗效好，但安全性存在问题，包括骨折。任何给定患者骨折风险的估计都因糖皮质激素使用的动态模式而复杂化，其中患者在糖皮质激素使用的剂量，持续时间和时间方面各不相同。调查目前使用哪些方法将骨折归因于糖皮质激素暴露，并调查这些方法是否可以考虑个体治疗模式。38项研究使用了5种常见的糖皮质激素暴露风险归因定义：“当前使用”、“曾经使用”、“日剂量”、“累积剂量”和“时间变量”。一项研究试图将联合收割机的多个定义结合起来，其中“累积剂量”嵌套在“每日剂量”中，涵盖剂量和持续时间的影响，但不包括时间。大多数结果表明，随着暴露量的增加，骨折的风险不确定或增加，尽管差异很大，比值比、风险比和相对风险范围为0.16至8.16。在定义范围内，结果也存在变异性，“时间变量”的最小范围为1.07至2.8，“累积剂量”的最大范围为0.88至8.12。许多研究探讨了糖皮质激素对RA患者骨折风险的影响。尽管如此，对于风险的大小并没有明确的共识。这是各种分析模型及其不同假设的结果。此外，目前没有分析方法可以考虑糖皮质激素治疗的剂量、持续时间和时机，从而无法清楚地了解患者的骨折风险及其个体治疗模式。对使用糖皮质激素导致骨折的危险因素进行了文献综述。糖皮质激素的危险因素有5种常用的确定方法，目前尚无考虑剂量、持续时间和时间的方法。由于糖皮质激素治疗的动态模式，剂量、持续时间和时机被认为会影响骨折的风险。
Glucocorticoid therapy is used widely in patients with rheumatoid arthritis (RA) with good efficacy but concerns about safety including fractures. Estimates of fracture risk for any given patient are complicated by the dynamic pattern of glucocorticoid use, where patients vary in their dose, duration and timing of glucocorticoid use. To investigate which methods are currently used to attribute fractures to glucocorticoid exposure and investigate whether such methods can consider individual treatment patterns. Thirty-eight studies used five common definitions of risk attribution to glucocorticoid exposure: “current use”, “ever use”, “daily dose”, “cumulative dose” and “time variant”. One study attempted to combine multiple definitions where “cumulative dose” was nested within “daily dose”, covering the effects of dose and duration but not timing. The majority of results demonstrated an equivocal or increased risk of fracture with increased exposure, although there was wide variation, with odds ratios, hazard ratios and relative risks ranging from 0.16 to 8.16. Within definitions there was also variability in the results with the smallest range for “time variant”, 1.07 to 2.8, and the largest for “cumulative dose”, ranging from risk estimates of 0.88 to 8.12. Many studies have looked into the effect of glucocorticoids on fracture risk in patients with RA. Despite this, there is no clear consensus about the magnitude of risk. This is a consequence of the varied analysis models and their different assumptions. Moreover, no current analysis method allows consideration of dose, duration and timing of glucocorticoid therapy, preventing a clear understanding of fracture risk for patients and their individual treatment patterns. A literature review on which methods are used to define risk attribution of glucocorticoid use to fractures was undertaken. Five common methods of defining risk attribution of glucocorticoids were found. No currently used method considers dose, duration and timing. Dose, duration and timing are thought to affect the risk of fracture due to the dynamic patterns of glucocorticoid therapy.