Comparison of orally administered bisphosphonate drugs in reducing the risk of hip fracture in older adults: a population-based cohort study.
Comparison of orally administered bisphosphonate drugs in reducing the risk of hip fracture in older adults: a population-based cohort study.
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DOI：
10.9778/cmajo.20130036
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发表时间：
2013-09-01
期刊：
影响因子：
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通讯作者：
Dormuth, Colin R
中科院分区：
文献类型：
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作者：
Cadarette, Suzanne M;Levesque, Linda;Dormuth, Colin R
背景：口服双膦酸盐药物（即，阿仑膦酸盐、依替膦酸盐、利塞膦酸盐）可以降低椎骨骨折的风险。然而，只有阿仑膦酸钠和利塞膦酸钠已被证明在降低髋部骨折风险方面有效。我们试图研究口服双膦酸盐药物在减少老年人髋部骨折的比较有效性。方法：我们确定了2001年和2008年之间在不列颠哥伦比亚省和安大略口服双膦酸盐药物的新用户。我们使用了省和性别特异性倾向评分匹配策略，以最大限度地提高暴露组之间的可比性。我们使用考克斯比例风险模型，比较各省不同性别暴露者治疗后1年内发生髋部骨折的时间。我们的二次分析考虑了2年和3年随访内的髋部骨折率。我们使用阿仑膦酸钠作为所有比较的参考，并汇集省估计使用随机效应方差加权荟萃analys.RESULTS：我们确定了321755例患者谁有资格纳入本研究。我们发现服用利塞膦酸钠的男性（合并风险比[HR] 0.94，95%置信区间[CI] 0.74-1.14）或女性（合并HR 1.15，95% CI 0.73-1.56）与服用阿仑膦酸钠的患者之间骨折率差异不大。我们同样发现，服用依替膦酸盐和阿仑膦酸盐的女性之间骨折发生率差异不大（合并HR 1.00，95% CI 0.82-1.18）。然而，我们发现服用依替膦酸盐的男性髋部骨折发生率低于阿仑膦酸盐（合并HR 0.77，95% CI 0.60-0.94）。2年和3年随访结果相似。然而，3年的随访，髋部骨折的发生率较低的妇女在不列颠哥伦比亚省谁采取了阿仑膦酸钠。解释：我们确定阿仑膦酸钠和利塞膦酸钠之间的差异不大，在降低男性或女性髋部骨折的风险。我们发现依替膦酸盐与男性骨折风险较低相关，这可能是由于选择偏倚。口服双膦酸盐药物的长期比较效果值得进一步研究。
BACKGROUND: Orally administered bisphosphonate drugs (i.e., alendronate, etidronate, risedronate) can reduce the risk of vertebral fracture. However, only alendronate and risedronate have proven efficacy in reducing the risk of hip fracture. We sought to examine the comparative effectiveness of orally administered bisphosphonate drugs in reducing hip fractures among older adults.METHODS: We identified new users of orally administered bisphosphonate drugs in British Columbia and Ontario between 2001 and 2008. We used province- and sex-specific propensity score-matching strategies to maximize comparability between exposure groups. We used Cox proportional hazards models to compare time-to-hip fracture within 1 year of treatment between exposures by sex in each province. Our secondary analyses considered hip fracture rates within 2 and 3 years' follow-up. We used alendronate as the reference for all comparisons and pooled provincial estimates using random effects variance-weighted meta-analysis.RESULTS: We identified 321755 patients who were eligible for inclusion in the study. We found little difference in fracture rates between men (pooled hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.74-1.14) or women (pooled HR 1.15, 95% CI 0.73-1.56) taking risedronate and those taking alendronate. We similarly identified little difference in fracture rates between women taking etidronate and those taking alendronate (pooled HR 1.00, 95% CI 0.82-1.18). However, we identified lower rates of hip fracture among men taking etidronate relative to alendronate (pooled HR 0.77, 95% CI 0.60-0.94). Results extended to 2 and 3 years' follow-up were similar. However, with 3 years' follow-up, rates of hip fracture were lower among women in British Columbia who had taken alendronate.INTERPRETATION: We identified little overall difference between alendronate and risedronate in reducing the risk of hip fracture in men or women. Our finding that etidronate is associated with lower fracture risk among men is likely due to selection bias. The long-term comparative effects of orally administered bisphosphonate drugs warrant further study.