Fracture risk with intermittent high-dose oral glucocorticoid therapy
Fracture risk with intermittent high-dose oral glucocorticoid therapy
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DOI：
10.1002/art.22294
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
van Staa, Tjeerd P.
中科院分区：
文献类型：
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作者：
de Vries, Frank;Bracke, Madelon;van Staa, Tjeerd P.
Objective.评估接受大剂量口服糖皮质激素（GCs）间歇治疗的患者发生骨折的风险。研究组包括来自英国全科医学数据库的191，752名患者，年龄在40岁及以上，接受GC治疗。随访时间段分为“当前”和“无暴露”两类。“确定了每个时间段的每日剂量和累积剂量。使用考克斯比例风险模型估计相对风险，校正年龄、性别、体重指数、吸烟、疾病史和药物史。桡骨/尺骨骨折、肱骨骨折、肋骨骨折、股骨/髋关节骨折、骨盆骨折或椎骨骨折均纳入评估范围。间歇性接受高剂量GC（日剂量≥ 15 mg）且既往无或很少暴露于GC（累积暴露量：51 gm）的患者发生股骨（但非髋/股骨）骨折的风险略有增加;该风险随累积暴露量增加而显著增加。在接受日剂量≥ 30 mg且累积暴露量> 5 gm的患者中，骨质疏松性骨折的相对危险度（RR）为3.63（95%可信区间[95%CI] 2.54-5.20），髋/股骨骨折的RR为3.13（95%CI 1.49-6.59），椎体骨折的RR为14.42（95%CI 8.29-25.08）。间歇性使用高剂量口服GC（日剂量>= 15 mg，累积暴露> 1 gm）可能导致骨质疏松性骨折风险小幅增加。相反，接受几个疗程的高剂量GC（日剂量>= 15 mg，累积暴露> 1 gm）的患者骨折风险显著增加。
Objective. To evaluate the risk of fracture in patients receiving intermittent therapy with high-dose oral glucocorticoids (GCs).Methods. The study group comprised 191,752 patients from the UK General Practice Database who were 40 years of age and older and received therapy with GCs. The followup time period was divided into the categories of "current" and "no exposure." The daily dose and cumulative dose for each time period were determined. Relative risks were estimated using Cox proportional hazards models, adjusted for age, sex, body mass index, smoking, disease history, and drug history. Fractures of the radius/ulna, humerus, rib, femur/hip, pelvis, or vertebrae were included in the evaluation.Results. Patients who intermittently received high-dose GCs (daily dose >= 15 mg) and had no or little previous exposure to GCs (cumulative exposure :51 gm) had a small increased risk of osteoporotic (but not hip/femur) fracture; this risk increased substantially with increasing cumulative exposure. Among patients who received a daily dose >= 30 mg and whose cumulative exposure was > 5 gm, the relative risk (RR) of osteoporotic fracture was 3.63 (95% confidence interval [95% CI] 2.54-5.20), the RR of fracture of the hip/femur was 3.13 (95% CI 1.49-6.59), and the RR of vertebral fracture was 14.42 (95% CI 8.29-25.08).Conclusion. Intermittent use of high-dose oral GCs (daily dose >= 15 mg and cumulative exposure > 1 gm) may result in a small increased risk of osteoporotic fracture. Conversely, patients who receive several courses of high-dose GCs (daily dose >= 15 mg and cumulative exposure > 1 gm) have a substantially increased risk of fracture.