Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Pharmacotherapy, University Utrecht, 3508 TB Utrecht, The Netherlands.
J Clin Endocrinol Metab. 2010 Apr;95(4):1924-31. doi: 10.1210/jc.2009-2342. Epub 2010 Feb 3.
Use of organic nitrates has been associated with increased bone mineral density. Moreover, a large Danish case-control study reported a decreased fracture risk. However, the association with duration of nitrate use, dose frequency, and impact of discontinuation has not been extensively studied.
Our objective was to evaluate the association between organic nitrates and hip fracture risk.
A case-control study was conducted using the Dutch PHARMO Record Linkage System (1991-2002, n = 6,763 hip fracture cases and 26,341 controls). Cases had their first admission for hip fracture, whereas controls had not sustained any fracture after enrollment. Current users of organic nitrates were patients who had received a prescription within 90 d before the index date. The analyses were adjusted for disease and drug history.
Current use of nitrates was not associated with a decreased risk of hip fracture [adjusted odds ratio (OR) = 0.93; 95% confidence interval (CI) = 0.83-1.04]. Those who used as-needed medication only had a lower risk of hip fracture (adjusted OR = 0.83; 95% CI = 0.63-1.08) compared with users of maintenance medication only (adjusted OR = 1.17; 95% CI = 0.97-1.40). No association was found between duration of nitrate use and fracture risk.
Our overall analyses showed that risk of a hip fracture was significantly lower among users of as-needed organic nitrates, when compared with users of maintenance medication. Our analyses of hip fracture risks with duration of use did not further support a beneficial effect of organic nitrates on hip fracture, although residual confounding may have masked beneficial effects.
使用有机硝酸盐与骨矿物质密度增加有关。此外，一项大型丹麦病例对照研究报告称，骨折风险降低。然而，硝酸盐使用持续时间、剂量频率和停药影响的相关性尚未得到广泛研究。
我们的目的是评估有机硝酸盐与髋部骨折风险之间的关系。
采用荷兰 PHARMO 记录链接系统（1991-2002 年）进行病例对照研究（n = 6763 例髋部骨折病例和 26341 例对照）。病例组为首次因髋部骨折入院，而对照组在入组后未发生任何骨折。当前使用有机硝酸盐的患者是在指数日期前 90 天内接受处方的患者。分析调整了疾病和药物史。
当前使用硝酸盐与髋部骨折风险降低无关（调整后的优势比 [OR] = 0.93；95%置信区间 [CI] = 0.83-1.04）。仅按需使用药物的患者髋部骨折风险较低（调整后的 OR = 0.83；95%CI = 0.63-1.08），而仅维持治疗的患者髋部骨折风险较高（调整后的 OR = 1.17；95%CI = 0.97-1.40）。未发现硝酸盐使用持续时间与骨折风险之间的关联。
我们的总体分析表明，与仅使用维持治疗的患者相比，按需使用有机硝酸盐的患者髋部骨折风险显著降低。我们对使用持续时间与髋部骨折风险的分析并未进一步支持有机硝酸盐对髋部骨折有益的作用，尽管残留混杂因素可能掩盖了有益的作用。
