Department of Physical Therapy, University of Alberta, 1F1.52 WMC, 8440 112 ST, Edmonton, AB T6G2B7, Canada.
Osteoporos Int. 2011 Mar;22(3):983-91. doi: 10.1007/s00198-010-1411-2. Epub 2010 Nov 4.
Intravenous bisphosphonates reduce mortality following hip fracture. We determined whether new use of oral bisphosphonates was also associated with reductions in mortality in 209 hip fracture patients. Oral bisphosphonate exposure led to relative reduction of 8% per month of use (p = 0.001) or about a 60% reduction in mortality per year of use.
Intravenous bisphosphonates reduce mortality following hip fracture. Using prospectively collected long-term data from a randomized trial of osteoporosis quality improvement for hip fracture, we determined whether new use of oral bisphosphonates was associated with reductions in mortality or the composite outcome of death or new fracture.
Originally, 220 hip fracture patients were randomized to case manager (n = 110) or usual care followed by facilitated bone mineral density (BMD) testing (n = 110) interventions. All were eligible for bisphosphonate treatment. Post-randomization, we followed patients for 3 years and ascertained bisphosphonate treatment, medication adherence and persistence, all-cause mortality, and new clinical fractures. Proportional hazards analyses with time-varying treatment status were undertaken.
The final study cohort included 209 patients: 136 (65%) females, 104 (50%) older than 75 years, 90 (43%) with poor self-reported health, and 38 (18%) underweight. Of these, 76 (36%) had a previous fracture before hip fracture and 132 (81%) had low BMD. A total of 101 (46%) patients started oral bisphosphonates and 65 (64%) remained on treatment at the final evaluation. Overall, 24 (11%) patients died, 19 (9%) had new fractures, and 42 (20%) reached the composite outcome of death or fracture. Compared to no treatment, bisphosphonate exposure was independently associated with reduced mortality (17[16%] vs. 7[7%]; adjusted hazard ratio (aHR) = 0.92 per month treated; 95%CI, 0.88-0.97) and composite endpoints (28[26%] vs. 5[15%]; aHR = 0.94 per month treated; 95%CI, 0.91-0.97).
Like intravenous bisphosphonates after hip fracture, our study suggests that oral bisphosphonates may be associated with reductions in all-cause mortality.
静脉用双膦酸盐可降低髋部骨折后的死亡率。我们旨在确定新使用口服双膦酸盐是否也与 209 例髋部骨折患者的死亡率降低相关。口服双膦酸盐的使用与使用时间每月减少 8%相关（p=0.001），或每年的死亡率降低约 60%。
使用髋部骨折骨质疏松质量改进的随机试验中前瞻性收集的长期数据，我们最初将 220 例髋部骨折患者随机分为病例管理者组（n=110）或常规护理组，随后进行促进骨密度（BMD）检测（n=110）。所有患者均符合双膦酸盐治疗条件。随机分组后，我们对患者随访 3 年，并确定双膦酸盐治疗、药物依从性和持久性、全因死亡率和新的临床骨折情况。采用时间依赖性治疗状态的比例风险分析。
最终研究队列包括 209 例患者：136 例（65%）为女性，104 例（50%）年龄大于 75 岁，90 例（43%）自我报告健康状况不佳，38 例（18%）体重过轻。其中，76 例（36%）在髋部骨折前有过其他部位骨折，132 例（81%）BMD 较低。共有 101 例（46%）患者开始口服双膦酸盐，65 例（64%）在最终评估时仍在接受治疗。总的来说，24 例（11%）患者死亡，19 例（9%）发生新骨折，42 例（20%）达到死亡或骨折的复合终点。与未治疗相比，双膦酸盐暴露与死亡率降低相关（17 例[16%]vs.7 例[7%]；调整后的危险比（aHR）为每月治疗 0.92；95%CI，0.88-0.97）和复合终点（28 例[26%]vs.5 例[15%]；aHR=每月治疗 0.94；95%CI，0.91-0.97）。
与髋部骨折后静脉用双膦酸盐类似，我们的研究表明，口服双膦酸盐可能与全因死亡率降低相关。
Zotero 插件