Department of Internal Medicine and Endocrinology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
Osteoporos Int. 2009 Apr;20(4):585-97. doi: 10.1007/s00198-008-0711-2. Epub 2008 Aug 9.
A nationwide case-control study was performed in 62,865 men aged 50+ using fracture data from the national hospital discharge register to screen all redeemed prescriptions in the past 5 years for significant mapping to fracture risk, employing measures to control for false discovery rate.
Osteoporosis in men is frequently related to alcohol abuse, hypogonadism, hypercalciuria, or the use of glucocorticoids. Very limited information is available on the impact of other medications on fracture risk in men.
We conducted a nationwide population-based case-control study collecting fracture data from the Danish National Hospital Discharge Register and prescriptions from the National Prescriptions Database (1995-2000). We included men aged 50+ years, with hospital-treated fractures in the year 2000 (n = 15,716), and age- and sex-matched controls (n = 47,149).
We identified 3.2 million redemptions of prescriptions for 1,073 different drugs. The analysis confirmed associations between fracture risk and use of sedatives, anti-epileptics, anti-psychotics, anxiolytics, SSRI, opioids and other analgesics, loop diuretics, and glucorticoids. New associations were also found. We observed an odds ratio (OR [95% CI] for any fracture) for fracture in users of dopaminergic agents (1.6 [1.3-1.9]) and iron compounds (1.2 [1.1-1.5]). The largest impact on fracture risk at population level was exerted by loop diuretics and analgesics.
An array of drugs is associated with fracture risk in men. The "prescriptiome" analysis can be used as a surveillance tool for drug-induced osteoporosis and in the planning of preventive measures.
本研究在丹麦开展了一项全国范围内的病例对照研究，共纳入 62865 名 50 岁以上男性，使用全国住院登记系统中的骨折数据来筛选过去 5 年中所有与骨折风险显著相关的处方药物，通过控制假发现率的方法对其进行评估。
男性骨质疏松症通常与酗酒、性腺功能减退、高钙尿症或皮质类固醇的使用有关。关于其他药物对男性骨折风险的影响，目前仅有非常有限的信息。
我们开展了一项全国性基于人群的病例对照研究，从丹麦国家住院登记系统中收集骨折数据，从全国处方数据库（1995-2000 年）中收集处方信息。我们纳入了年龄 50 岁以上、2000 年因骨折住院治疗的男性患者（n=15716），以及年龄和性别匹配的对照者（n=47149）。
我们共确定了 320 万张处方的使用记录，涉及 1073 种不同的药物。分析结果证实了骨折风险与镇静剂、抗癫痫药、抗精神病药、抗焦虑药、SSRIs、阿片类药物和其他镇痛药、噻嗪类利尿剂和皮质类固醇的使用之间存在关联。此外，还发现了一些新的关联。我们观察到使用多巴胺能药物（比值比[95%可信区间]为任何骨折）和铁化合物（1.2[1.1-1.5]）的患者骨折的比值比（OR）增加。在人群水平上，对骨折风险影响最大的是噻嗪类利尿剂和镇痛药。
许多药物与男性骨折风险相关。“处方组学”分析可作为监测药物性骨质疏松症的工具，有助于制定预防措施。
