Fractures in a nationwide population-based cohort of users of breast cancer hormonal therapy
Fractures in a nationwide population-based cohort of users of breast cancer hormonal therapy
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DOI：
10.1007/s11764-017-0666-4
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发表时间：
2018-04-01
影响因子：
3.7
通讯作者：
Charlson, John A.
中科院分区：
文献类型：
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作者：
Neuner, Joan M.;Shi, Yushu;Charlson, John A.
虽然在一些随机试验中，芳香酶抑制剂的使用者有更高的总体骨折风险，但在临床试验之外或在较老的高风险队列中，对其风险知之甚少。在一项基于人群的回溯性队列研究中，我们确定了所有在2006-2008年间首次接受乳腺癌手术并在随后一年内开始激素治疗(芳香酶抑制剂或他莫昔芬)的美国联邦医疗保险D处方药保险计划中的老年女性。使用一种经过验证的算法确定了2012年的所有非脊椎和髋部骨折。骨折结局与激素治疗类型的相关性通过竞争性风险回归模型进行评估，这些模型解释了测量的基线协变量的差异。在23378名接受激素治疗的女性(23.2%年龄在80岁或以上)中，总共有3000名髋部骨折，其中436名。尽管人工智能用户更年轻，共病发生率更低，但在倾向分数加权后，这些变量和其他协变量是平衡的。与他莫昔芬相比，使用人工智能的患者总的非椎体骨折风险较高，HR为1.11(1.02-1.21)，但髋部骨折风险的小幅增加没有统计学意义，HR为1.04(0.84-1.30)。尽管人工智能用户的总非椎体骨折风险较高，但在大量基于人群的老年女性队列中，髋部骨折的差异并不显著。老年女性使用芳香酶抑制剂与非椎体骨折的高风险相关，与使用他莫昔芬相比，非椎体骨折的风险增加。在服用这些药物的患者中，应评估骨折风险。
Although users of aromatase inhibitors have higher total fracture risk in some randomized trials, little is known about their risk outside of clinical trials or in older higher-risk cohorts.In a population-based retrospective cohort study, we identified all older US Medicare D prescription drug insurance plan-enrolled women who had initial breast cancer surgery in 2006-2008 and began hormonal therapy (an aromatase inhibitor (AI) or tamoxifen) within the subsequent year. Total nonvertebral and hip fractures through 2012 were identified using a validated algorithm. The association of fracture outcomes with hormonal therapy type was assessed using competing risk regression models that accounted for differences in measured baseline covariates. Treatment assignment bias was reduced using inverse probability of treatment weighting computed from propensity scores.Among 23,378 women taking hormonal therapy (23.2% aged 80 or over), there were 3000 total and 436 hip fractures. Although AI users were younger and had lower comorbidity, after propensity score weighting, these and other covariates were balanced. Total nonvertebral risk was higher for users of AIs compared with tamoxifen, HR 1.11 (1.02-1.21), but the small increase in risk for hip fracture was not statistically significant, HR 1.04 (0.84-1.30).Although total nonvertebral fracture risk was higher among AI users, differences in hip fractures were not significant in a large population-based cohort of older women.Use of aromatase inhibitors by older women is associated with high risk for nonvertebral fracture that is increased compared with use of tamoxifen. Fracture risk should be assessed among patients taking these medications.