Vestergaard Peter, Rejnmark Lars, Mosekilde Leif
Department of Endocrinology and Metabolism C, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark.
Chest. 2007 Nov;132(5):1599-607. doi: 10.1378/chest.07-1092. Epub 2007 Sep 21.
Chronic lung diseases and drugs used to treat patients with chronic lung diseases may be associated with an increased fracture risk.
The design was a case-control study of all patients with a fracture (n=124,655) in the year 2000 in Denmark as case subjects. For each case subject, three age- and gender-matched control subjects were randomly drawn from the general population (n=373,962).
Chronic lung diseases such as COPD (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.13 to 1.25), emphysema (OR, 1.31; 95% CI, 1.16 to 1.48), and other chronic lung diseases (OR, 1.20; 95% CI, 1.00 to 1.44) were associated with a higher relative risk of any fracture than asthma (OR, 1.06; 95% CI, 1.01 to 1.12). Oral corticosteroids were associated with a dose-dependent increased risk of fractures. Inhaled short-acting beta-agonists were associated with an increase in fracture risk that was not dose dependent and was seen already at low doses. Oral beta-agonists were associated with an increase in fracture risk at low doses but not at higher doses. Other bronchodilators (inhaled long-acting beta-agonists, inhaled beta-agonists plus inhaled corticosteroids, inhaled beta-agonists plus antimuscarinic substances, inhaled antimuscarinic substances, inhaled cromoglycate and cromoglycate-like substances, oral theophylline, and oral leukotriene receptor antagonists), and inhaled corticosteroids were not associated with fracture risk.
The increase in fracture risk seen with inhaled short-acting beta-agonists may be linked to the severity of the underlying lung disease rather than with the beta-agonists, per se, as other types of beta-agonists were not associated with fractures.
慢性肺部疾病以及用于治疗慢性肺部疾病患者的药物可能与骨折风险增加有关。
该研究设计为一项病例对照研究，以2000年丹麦所有骨折患者（n = 124,655）作为病例组。对于每个病例组对象，从普通人群中随机抽取三名年龄和性别匹配的对照对象（n = 373,962）。
慢性阻塞性肺疾病（COPD）（比值比[OR]，1.19；95%置信区间[CI]，1.13至1.25）、肺气肿（OR，1.31；95%CI，1.16至1.48）以及其他慢性肺部疾病（OR，1.20；95%CI，1.00至1.44）与任何骨折的相对风险高于哮喘（OR，1.06；95%CI，1.01至1.12）相关。口服皮质类固醇与剂量依赖性骨折风险增加相关。吸入性短效β受体激动剂与骨折风险增加相关，且这种增加不依赖剂量，在低剂量时即可出现。口服β受体激动剂在低剂量时与骨折风险增加相关，但在高剂量时不相关。其他支气管扩张剂（吸入性长效β受体激动剂、吸入性β受体激动剂加吸入性皮质类固醇、吸入性β受体激动剂加抗毒蕈碱物质、吸入性抗毒蕈碱物质、吸入性色甘酸和色甘酸类似物、口服茶碱以及口服白三烯受体拮抗剂）以及吸入性皮质类固醇与骨折风险无关。
吸入性短效β受体激动剂导致的骨折风险增加可能与潜在肺部疾病的严重程度有关，而非与β受体激动剂本身有关，因为其他类型的β受体激动剂与骨折无关。
