Use of beta-2 agonists and risk of hip/femur fracture: a population-based case-control study
Use of beta-2 agonists and risk of hip/femur fracture: a population-based case-control study
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β2 激动剂的使用与髋部/股骨骨折的风险：一项基于人群的病例对照研究
DOI：
10.1002/pds.1318
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发表时间：
2007-06-01
影响因子：
2.6
通讯作者：
van Staa, Tjeerd-Pieter
中科院分区：
文献类型：
--
作者：
de Vries, Frank;Pouwels, Sander;van Staa, Tjeerd-Pieter
简介 给予 β-2 激动剂可降低大鼠的骨矿物质密度。但支气管扩张剂与骨折风险之间的关联尚未在人类中进行过研究。 目的 探讨使用 β-2 激动剂与髋部/股骨骨折风险之间的关联。 方法 我们在荷兰 PHARMO 数据库中进行了一项基于人群的病例对照研究（6763 例）。将目前使用 β-2 激动剂与从未使用的情况进行比较。我们根据基础呼吸系统疾病和疾病的严重程度以及用药史进行了调整。结果 在索引日期前一年因哮喘/慢性阻塞性肺病住院会增加髋部/股骨骨折的风险：粗 OR 2.17（95% CI，1.41-3.34）。使用较高剂量β-2受体激动剂的患者髋部/股骨骨折的风险增加：每日剂量≥1600μg沙丁胺醇当量的粗OR为1.94（95％CI，1.41-2.66）。调整疾病严重程度后（1.46；95% CI，1.02-2.08）并排除口服糖皮质激素使用者（1.31；95% CI，0.80-2.15）后，过度骨折风险降低。 β-2 激动剂、吸入性糖皮质激素和抗胆碱能药物使用者之间髋部/股骨骨折的风险相似。结论我们发现使用较高剂量的 β-2 激动剂的住院患者髋部/股骨骨折的风险增加。然而，在排除口服糖皮质激素使用者并调整基础疾病后，髋部/股骨骨折的过度风险大大降低。使用 β2 受体激动剂、吸入性糖皮质激素和抗胆碱能药物的使用者发生髋部/股骨骨折的风险相似。使用β2激动剂的患者髋部/股骨骨折的病因可能与基础疾病的严重程度有关，而不是β2激动剂的使用情况。版权所有 (C) 2006 John Wiley & Sons, Ltd.
Introduction Administration of beta-2 agonists decreased bone mineral density in rats. But the association between bronchodilators and fracture risk has not been studied in humans.Objectives To examine the association between use of beta-2 agonists and risk of hip/femur fracture.Methods We conducted a population-based case-control study (6763 cases) in the Dutch PHARMO database. Current beta-2 agonist use was compared to never use. We adjusted for severity of the underlying respiratory disease and disease and drug history.Results A hospitalisation for asthma/COPD in the year before index date increased risk of hip/femur fracture: crude OR 2.17 (95% CI, 1.41-3.34). Patients using higher doses of beta-2 agonists had increased risk of hip/femur fracture: crude OR 1.94 (95% CI, 1.41-2.66) for daily dosages of >= 1600 mu g albuterol equivalent. The excess fracture risk reduced after adjustment for disease severity (1.46; 95% CI, 1.02-2.08) and after exclusion of oral glucocorticoid users (1.31; 95% CI, 0.80-2.15). Risk of hip/femur fracture was similar between users of beta-2 agonists, inhaled glucocorticoids and anticholinergics.Conclusion We found increases in the risk of hip/femur fracture inpatients using higher doses of beta-2 agonists. However, the excess risk of hip/femur fracture substantially reduced after exclusion of oral glucocorticoid users and after adjustment for the underlying disease. Risk of hip/femur fracture was similar between users of beta-2 agonists, inhaled glucocorticoids and anticholinergics. The severity of the underlying disease, rather than the use of beta-2 agonists, may play an important role in the aetiology of hip/femur fractures in patients using beta-2 agonists. Copyright (C) 2006 John Wiley & Sons, Ltd.