Alendronate use and bone mineral density gains in women with moderate-severe (stages 3B-5) chronic kidney disease: an open cohort multivariable and propensity score analysis from Funen, Denmark.
Alendronate use and bone mineral density gains in women with moderate-severe (stages 3B-5) chronic kidney disease: an open cohort multivariable and propensity score analysis from Funen, Denmark.
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DOI：
10.1007/s11657-020-00746-z
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发表时间：
2020-06-01
影响因子：
3
通讯作者：
Prieto-Alhambra D
中科院分区：
文献类型：
--
作者：
Ali MS;Ernst M;Robinson DE;Caskey F;Arden NK;Ben-Shlomo Y;Nybo M;Rubin KH;Judge A;Cooper C;Javaid MK;Hermann AP;Prieto-Alhambra D
双膦酸盐禁用于中度至重度慢性肾脏病患者。然而，它们被用来预防肾功能受损患者的脆性骨折，尽管缺乏证据表明它们对这些患者骨密度的影响。我们证明阿仑膦酸钠对这些患者的骨骼有积极的影响。本研究旨在评估阿仑膦酸钠的使用与中重度慢性肾病 (CKD) 受试者的骨矿物质密度 (BMD) 变化之间的关联。我们将丹麦 Funen 地区所有基于 DXA 的测量结果与生物化学、国家健康登记处和处方处方联系起来，创建了一组 CKD 3B-5 期患者。暴露是阿仑膦酸钠的分配，结果是股骨颈、全髋部和腰椎的 BMD 年化百分比变化。从第一次 BMD 到最新的后续 DXA 测量，对个体进行跟踪。使用发病密度抽样确定阿仑膦酸钠非使用者，并使用倾向评分创建匹配组。线性回归用于估计年化 BMD 的平均差异。在这组患者中很少使用阿仑膦酸钠：倾向评分匹配 (PSM) 结果显示，71 名阿仑膦酸钠使用者和 142 名非使用者患有 3B-5 期 CKD（如 DXA 前 1 年）。阿仑膦酸钠使用者的股骨颈 BMD 每年平均增加 1.07%，而非使用者的股骨颈 BMD 每年平均下降 1.59%。股骨颈、全髋和脊柱 BMD 的 PSM 年化 BMD 平均差异分别为 + 2.65%（1.32%、3.99%）、+3.01%（1.74%、4.28%）和 + 2.12%（0.98%、3.25%），所有这些均有利于阿仑膦酸钠使用者。在现实世界的 3B-5 期 CKD 女性队列中，使用阿仑膦酸钠似乎与股骨颈、全髋关节和脊柱 BMD 每年显着改善 2-3% 相关。需要更多关于双磷酸盐治疗中重度 CKD 的抗骨折有效性和安全性的数据。
Bisphosphonates are contraindicated in moderate-to-severe chronic kidney disease patients. However, they are used to prevent fragility fractures in patients with impaired kidney function, despite a lack of evidence on their effects on bone density in these patients. We demonstrated that Alendronate had a positive effect on bone in these patients. This study aimed to assess the association between alendronate use and bone mineral density (BMD) change in subjects with moderate-severe chronic kidney disease (CKD). We created a cohort of CKD stage 3B–5 patients by linking all DXA-based measurements in the Funen area, Denmark, to biochemistry, national health registries and filled prescriptions. Exposure was dispensation of alendronate and the outcome was annualized percentage change in BMD at the femoral neck, total hip and lumbar spine. Individuals were followed from first BMD to the latest of subsequent DXA measurements. Alendronate non-users were identified using incidence density sampling and matched groups were created using propensity scores. Linear regression was used to estimate average differences in the annualized BMD. Use of alendronate was rare in this group of patients: propensity score matching (PSM) resulted in 71 alendronate users and 142 non-users with stage 3B–5 CKD (as in the 1 year before DXA). Whilst alendronate users gained an average 1.07% femoral neck BMD per year, non-users lost an average of 1.59% per annum. The PSM mean differences in annualized BMD were + 2.65% (1.32%, 3.99%), + 3.01% (1.74%, 4.28%) and + 2.12% (0.98%, 3.25%) at the femoral neck, total hip and spine BMD, respectively, all in favour of alendronate users. In a real-world cohort of women with stage 3B–5 CKD, use of alendronate appears associated with a significant improvement of 2–3% per year in the femoral neck, total hip and spine BMD. More data are needed on the anti-fracture effectiveness and safety of bisphosphonate therapy in moderate-severe CKD.
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影响因子：
2.3
作者：
Kinsella S;Murphy K;Breen M;O'Neill S;McLaughlin P;Coyle J;Bogue C;O'Neill F;Moore N;McGarrigle A;Molloy MG;Maher MM;Eustace JA
通讯作者：
Eustace JA
影响因子：
13.2
作者：
Dooley, Annemarie C.;Weiss, Noel S.;Kestenbaum, Bryan
通讯作者：
Kestenbaum, Bryan
影响因子：
4
作者：
Maravic, M.;Ostertag, A.;Cohen-Solal, M.
通讯作者：
Cohen-Solal, M.
影响因子：
158.5
作者：
McClung, MR;Geusens, P;Chestnut, CH
通讯作者：
Chestnut, CH
影响因子：
120.7
作者：
Harris, ST;Watts, NB;Miller, PD
通讯作者：
Miller, PD