Intramural Research Program, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
J Bone Miner Res. 2011 Mar;26(3):553-60. doi: 10.1002/jbmr.233.
Increasing numbers of atypical hip fractures have been reported among patients with bisphosphonate use. However, the nature and extent of the problem are unknown despite recent investigations. To analyze national trends in hip fractures and medication use in the elderly US population, we respectively used the Nationwide Inpatient Sample (NIS) and the Medical Expenditure Panel Survey (MEPS) from 1996 to 2007. In NIS, subtrochanteric fragility fractures were compared with typical hip fractures in femoral neck and intertrochanteric regions. Between 1996 and 2007, age-adjusted rates for typical hip fractures decreased by 31.6% among women (from 1020.5 to 697.4 per 100,000 population) and 20.5% among men (from 424.9 to 337.6 per 100,000 population). In contrast, overall trends in age-adjusted rates for subtrochanteric fragility fractures remained unchanged among men (p = .34) but increased 20.4% among women from 28.4 (95% confidence interval [CI] 27.7-29.1) in 1999 to 34.2 (95% CI 33.4-34.9) per 100,000 population in 2007. The annual percentage increase was 2.1% (95% CI 1.3-2.8, p < .001) based on joinpoint regression analysis. In MEPS, bisphosphonate use increased predominantly in women (from 3.5% in 1996 to 16.6% in 2007) compared with men (2.3% in 2007). In the context of declining typical hip fractures among the US elderly, we observed small but significant increases in the incidence of subtrochanteric fragility fractures from 1999 among postmenopausal women. Using age-adjusted rates, we estimated that for every 100 or so reduction in typical femoral neck or intertrochanteric fractures, there was an increase of one subtrochanteric fragility fracture.
越来越多的报告称，使用双磷酸盐的患者出现了非典型髋部骨折。然而，尽管最近进行了调查，但仍不清楚该问题的性质和程度。为了分析美国老年人群髋部骨折和药物使用的全国趋势，我们分别使用了 1996 年至 2007 年的全国住院患者样本（NIS）和医疗支出面板调查（MEPS）。在 NIS 中，转子下脆性骨折与股骨颈和转子间区域的典型髋部骨折进行了比较。1996 年至 2007 年间，女性的典型髋部骨折年龄调整发病率下降了 31.6%（从每 10 万人 1020.5 例降至 697.4 例），男性下降了 20.5%（从每 10 万人 424.9 例降至 337.6 例）。相比之下，男性转子下脆性骨折的年龄调整发病率总体趋势保持不变（p=0.34），但女性发病率从 1999 年的每 10 万人 28.4 例（95%置信区间 [CI] 27.7-29.1）增加到 2007 年的每 10 万人 34.2 例（95% CI 33.4-34.9），2007 年增加了 20.4%。基于 Joinpoint 回归分析，年增长率为 2.1%（95% CI 1.3-2.8，p<0.001）。在 MEPS 中，双磷酸盐的使用主要在女性中增加（从 1996 年的 3.5%增加到 2007 年的 16.6%），而在男性中则增加较少（2007 年为 2.3%）。在美国老年人群中，典型髋部骨折减少的情况下，我们观察到绝经后女性转子下脆性骨折的发病率出现了小但显著的增加。使用年龄调整发病率，我们估计每减少 100 例左右的股骨颈或转子间典型骨折，就会增加 1 例转子下脆性骨折。
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