Bisphosphonate use after clinical fracture and risk of new fracture
Bisphosphonate use after clinical fracture and risk of new fracture
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DOI：
10.1007/s00198-017-4367-7
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发表时间：
2018-04-01
影响因子：
4
通讯作者：
Nordstrom, P.
中科院分区：
文献类型：
--
作者：
Bergman, J.;Nordstrom, A.;Nordstrom, P.
在既往有骨折的老年人中，骨质疏松症的治疗最初与新发骨折的风险较高相关。然而，随着时间的推移，新骨折的相对风险降低，这一趋势与有益效果一致，因为骨质疏松症的治疗是为了降低高骨折风险。本研究的目的是检查老年人临床骨折后使用双膦酸盐是否与新骨折风险降低相关。数据可用于3，329，2006年至2011年间，瑞典400名年龄≥ 50岁的成年人。在此期间，260，353例患者发生临床骨折，并且当时未使用双膦酸盐。那些随后接受双膦酸盐治疗的患者在性别、出生年份、最初骨折的类型和年份上与最多三个人相匹配。最后一组包括83，104名成年人（26.3%双膦酸盐使用者）。在从最初骨折到开始双膦酸盐治疗的这段时间里，任何新的临床骨折的发生率在后来成为双膦酸盐使用者的人中高于那些仍然不使用者（175.1 vs. 75.9/1000人-年;风险比2.30，95%置信区间2.19 - 2.41）。同样，在治疗的前6个月，双膦酸盐使用者的发生率高于非使用者（128.8 vs. 90.2/1000人-年;风险比1.41，95%置信区间1.32 - 1.51）。然而，这种差异随着时间的推移而减少：到12至18个月，使用者和非使用者的发病率相似（每1000人-年59.3 vs. 55.3;风险比1.03，95%置信区间0.91 - 1.16）。在双磷酸盐治疗期间，新骨折的相对风险降低，这一趋势与有益的治疗效果一致，因为双膦酸盐可用于降低高骨折风险。
Among older adults with a previous fracture, treatment for osteoporosis was initially associated with a higher risk of new fracture. However, the relative risk of new fracture decreased over time, a trend that is consistent with a beneficial effect, as treatment for osteoporosis is prescribed to reduce high fracture risks.The purpose of this study was to examine whether bisphosphonate use is associated with a lower risk of new fracture after a clinical fracture in older adults.Data were available for 3,329,400 adults in Sweden who were aged >= 50 years between 2006 and 2011. During this period, 260,353 sustained a clinical fracture and were na < ve to bisphosphonates at the time. Those who subsequently received a bisphosphonate were matched to up to three others on sex, year of birth, and type and year of initial fracture. The final cohort comprised 83,104 adults (26.3% bisphosphonate users).During the period from initial fracture to initiation of bisphosphonate treatment, the incidence rate of any new clinical fracture was higher in those who later became bisphosphonate users than in those who remained nonusers (175.1 vs. 75.9 per 1000 person-years; hazard ratio 2.30, 95% confidence interval 2.19 to 2.41). Similarly, during the first 6 months of treatment, the incidence rate was higher in bisphosphonate users than in nonusers (128.8 vs. 90.2 per 1000 person-years; hazard ratio 1.41, 95% confidence interval 1.32 to 1.51). However, this difference decreased over time: by months 12 to 18, the incidence rate was similar in users and nonusers (59.3 vs. 55.3 per 1000 person-years; hazard ratio 1.03, 95% confidence interval 0.91 to 1.16).There was a decrease in the relative risk of new fracture during bisphosphonate treatment, a trend that is consistent with a beneficial treatment effect, as bisphosphonates are prescribed to reduce high fracture risks.