Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland.
Pharmacoepidemiol Drug Saf. 2010 Jul;19(7):763-9. doi: 10.1002/pds.1972.
To determine the association, if any, between the prescribing of proton pump inhibitors and drugs for the management of osteoporosis.
The study employed a retrospective cohort design using the Irish Health Services Executive (HSE) Primary Care Reimbursement Services (PCRS) pharmacy database, which contains prescription information for 1.2 million people (30% of the population). Those aged 55 years and over were included. Individuals were classified as new PPI users if they initiated PPI therapy after 2003, and those not receiving PPI therapy after 2003 as the comparison group. Subsequent prescribing of anti-osteoporotic therapy was considered from 2004 to 2007 in both groups. Adjusted odds ratios (OR and 95%CIs) were determined by logistic regression, adjusting for age, gender and medications, which potentially affect bone mineral density.
442,341 patients were identified, 209 175 were PPI users and the 233,166 were used as the comparison group. The odds ratio (95%CI) for the prescribing of anti-osteoporotic therapies following the prescribing of PPIs was OR = 1.69 (95%CI 1.66 1.72) compared to not receiving any PPI therapy, when adjusted for age and sex. When adjustments were made for other confounders, the OR decreased to OR = 1.26 (95%CI 1.23-1.28). The strength of the association increased with increasing duration of PPI therapy 6-12 months OR = 1.19 (95%CI 1.15-1.23) and for >24 months, OR= 2.09 (95%CI 2.04, 2.13) compared to < 3 months. The OR also increased with increase in dose of therapy.
The results of the study indicate the association between the prescribing of bisphosphonates following the use of proton pump inhibitors may be clinically relevant.
确定质子泵抑制剂（PPI）和骨质疏松症管理药物的处方之间是否存在关联。
本研究采用回顾性队列设计，利用爱尔兰卫生服务行政署（HSE）初级保健报销服务（PCRS）药房数据库，该数据库包含 120 万人（占总人口的 30%）的处方信息。纳入年龄在 55 岁及以上的人群。如果患者在 2003 年后开始 PPI 治疗，则将其归类为新的 PPI 用户，而在 2003 年后未接受 PPI 治疗的患者作为对照组。在两组患者中，从 2004 年至 2007 年期间，考虑了后续抗骨质疏松治疗的处方情况。通过逻辑回归确定调整后的优势比（OR 和 95%CI），调整了年龄、性别和可能影响骨密度的药物。
共确定了 442341 名患者，其中 209175 名患者为 PPI 用户，233166 名患者作为对照组。与未接受任何 PPI 治疗相比，在调整年龄和性别因素后，PPI 治疗后开具抗骨质疏松治疗药物的可能性（OR=1.69，95%CI 1.66-1.72）。当调整其他混杂因素时，OR 降低至 OR=1.26（95%CI 1.23-1.28）。随着 PPI 治疗持续时间的增加，关联的强度也随之增加，6-12 个月的 OR=1.19（95%CI 1.15-1.23），超过 24 个月的 OR=2.09（95%CI 2.04，2.13），与 3 个月以下的相比。随着治疗剂量的增加，OR 也随之增加。
研究结果表明，质子泵抑制剂使用后开具双膦酸盐类药物的处方之间可能存在临床相关性。
