Clinical Interventions in Aging Dovepress Bisphosphonate Use and Hip Fracture Epidemiology: Ecologic Proof from the Contrary
Clinical Interventions in Aging Dovepress Bisphosphonate Use and Hip Fracture Epidemiology: Ecologic Proof from the Contrary
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老年 Dovepress 双膦酸盐使用和髋部骨折流行病学的临床干预措施：相反的生态学证据
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通讯作者：
Michael W. Davis
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作者：
A. Fisher;Jodie Martin;W. Srikusalanukul;Michael W. Davis
目的：本文的目的是评估2005-2008年间澳大利亚首都地区(ACT)抗骨质疏松药物处方的变化(主要是双磷酸盐[BP]的使用迅速下降)与标准化髋部骨折(HF)发生率之间的关系。方法：利用2006年澳大利亚人口普查，确定和标准化按性别和年龄划分的年心力衰竭发生率(每10万人)。从澳大利亚药品福利计划(PBS)和遣返澳大利亚药品福利计划(RPBS)数据库中获得了BP(主要是阿伦磷酸钠和利塞膦酸盐)、雷奈酸锶和激素替代疗法的年度处方数据。结果：在ACT中，BPS的年度处方数在2006年达到峰值。在有报道将颌骨骨坏死与BP的使用联系起来之后，2007-2008年间BP处方的数量与2005年相比下降了14%，当时HF的发生率最低。与2005年相比，2007年(+22.6%)和2008年(+25.2%)女性心力衰竭发生率上升的同时，BP处方的减少也是一致的；在男性中，心力衰竭发病率分别下降了6.6%和16.7%。2007-2008年雷奈酸锶、利塞膦酸锶和阿仑磷酸钠的处方配伍比例为1：8.4：15.5，表明苯磺酸锶是主要的抗骨质疏松药物。在1999年至2008年的10年间，每年服用BP处方的总数与标准化心力衰竭发病率之间存在显著的负相关关系。结论：尽管目前尚不清楚导致心力衰竭流行病学改变的因素，但现有证据表明心力衰竭发生率的下降在很大程度上是由于BP的使用。BPS使用率的下降与女性HF发生率的增加有关，这表明BPS仍应被视为预防和治疗骨质疏松症的一线药物。我们的结果需要在其他人口和国家得到证实。
Aim: The objective of this article is to evaluate the relationship between the changes in prescriptions of antiosteoporotic drugs (mainly the rapid fall in the use of bisphosphonates [BPs]) and standardized hip fracture (HF) rates over the period 2005–2008 in the Australian Capital Territory (ACT). Methods: Annual sex-and age-specific HF rates (per 100,000 population) were determined and standardized using the Australian 2006 population census. Data on the annual prescriptions of BPs (mainly alendronate and risedronate), strontium ranelate, and hormone replacement therapy were obtained from the Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Australian Pharmaceutical Benefits Scheme (RPBS) databases. Results: In the ACT, the peak annual number of prescriptions for BPs was observed in 2006. Following reports linking osteonecrosis of the jaw with BP use, the number of BP prescriptions dropped by 14% in 2007–2008 compared with 2005, when the lowest HF rates were recorded. The reduction in BP prescriptions coincided with increased HF rates in females in 2007 (+22.6%) and in 2008 (+25.2%) compared with 2005; in males, HF incidence declined by 6.6% and 16.7%, respectively. The proportion of filled prescriptions for strontium ranelate, risedronate, and alendronate in 2007–2008 was 1:8.4:15.5, indicating that BPs were the dominant antiosteoporotic drugs. There was an inverse statistically significant relationship between the total annual number of BP prescriptions and standardized HF incidence rates for the 10-year period 1999–2008. Conclusion: Although currently there is no clear understanding of factors contributing to changing HF epidemiology, the available evidence suggests that much of the decline in HF rates is due to the use of BPs. The fall in the use of BPs is associated with an increase in HF rates in females, indicating that BPs should still be considered the first-line medications for the prevention and treatment of osteoporosis. Our results need to be confirmed in other populations and countries.