Individual Antidepressants and the Risk of Fractures in Older Adults: A New User Active Comparator Study
Individual Antidepressants and the Risk of Fractures in Older Adults: A New User Active Comparator Study
复制标题
个体抗抑郁药与老年人骨折的风险：一项新用户主动比较研究
作者：
F. Pisa;J. Reinold;B. Kollhorst;U. Haug;T. Schink
目的探讨服用抗抑郁药(ADS)的老年人发生髋骨盆骨折和其他非椎体骨折的风险。方法我们进行了一项病例对照研究，该研究嵌套在2005年至2014年德国药物流行病学研究数据库(≥)中确定的年龄为65岁、既往无髋盆骨折或其他非脊椎骨折的ADS新使用者中。这些患者是首次因髋部骨盆或其他非脊椎骨折而住院的患者。采用发病率密度抽样法，每个病例最多选择100名对照。根据最后一次分配的供应量，在索引日期(ID)确定广告使用情况。调整后的优势比(AORS)和95%可信区间(CI)用条件Logistic回归估计，以米氮平的当前使用者为参考(主动比较器)。结果共有39853例髋盆骨折患者(80%为女性，中位年龄81岁)和31577例其他骨折患者(84%为女性，中位年龄79岁)与300万名对照组配对。对于髋盆骨折，当前使用者的AORS约为1.3，个体ADS之间的差异很小，范围从西酞普兰的1.33(95%可信区间1.27~1.39)到阿米替林的1.28(1.21~1.35)。对于其他骨折，目前使用西酞普兰(1.50；1.42-1.58)和度洛西汀(1.54；1.39-1.71)的患者AORS最高，阿米替林(1.18；1.11-1.26)和曲米帕明(1.16；1.03-1.29)最低。在所有检查的ADS中，其他骨折的AORS高于髋部骨盆骨折。结论不同的ADS药物发生骨折的风险不同，但对大多数药物而言，其风险高于米氮平。当使用ADS治疗老年人时，处方医生应该仔细考虑个体ADS关于骨折的风险概况，这是该人群的一个主要健康问题。
Objective To determine the risk of hip–pelvis and other non-vertebral fractures in older adults using antidepressants (ADs). Methods We conducted a case–control study nested in a cohort of new users of ADs aged ≥65 years without prior hip–pelvis or other non-vertebral fractures, identified in the German Pharmacoepidemiological Research Database (GePaRD) during 2005–2014. Cases were patients first hospitalized for hip–pelvis or other non-vertebral fractures. Up to 100 controls per case were selected using incidence density sampling. AD use was ascertained at index date (ID) based on the supply of last dispensing. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression with current users of mirtazapine as reference (active comparator). Results A total of 39,853 cases of hip–pelvis fracture (80% women, median age 81 years) and 31,577 cases of other fractures (84% women, median age 79 years) were matched to >3 million controls. For hip–pelvis fracture, aORs in current users were about 1.3 with little variation between individual ADs, ranging from 1.33 for citalopram (95% CI 1.27–1.39) to 1.28 for amitriptyline (1.21–1.35). For other fractures, the aORs were highest in current users of citalopram (1.50; 1.42–1.58) and duloxetine (1.54; 1.39–1.71) and lowest for amitriptyline (1.18; 1.11–1.26) and trimipramine (1.16; 1.03–1.29). For all examined ADs, the aORs were higher for other fractures than for hip–pelvis fracture. Conclusion The risk of fractures varies between ADs, but for most agents is higher than the risk for mirtazapine. When treating older adults with ADs, prescribers should carefully consider the risk profile of individual ADs regarding fractures, which are a major health problem in this population.