Oxford University Institute of Musculoskeletal Sciences, Oxford, United Kingdom.
J Bone Miner Res. 2013 Mar;28(3):455-63. doi: 10.1002/jbmr.1783.
Ocular inflammatory reactions have been described in patients on bisphosphonate treatment. We estimated the incidence rate of ocular inflammation at 3 and 12 months in patients treated for osteoporosis using a register-based cohort linked to prescription data (hospitals and private practice) and hospital data. From January 1, 1997 to December 31, 2007, a total of 88,202 patients beginning osteoporosis therapy were identified. Of those patients, 82,404 (93%) began oral bisphosphonates and 5798 (7%) nonbisphosphonates. Within the first year of treatment, 4769 (5.4%) of patients on osteoporosis therapy filled one or more prescriptions for topical eye steroids (TES). TES treatment rates (per 1000 patient-years) in the first year of osteoporosis treatment were 44 (95% confidence interval [CI] 42 to 46) for alendronate, 40 (95% CI 38 to 43) for etidronate, 45 (95% CI 35 to 57) for risedronate, 32 (95% CI 27 to 37) for raloxifene, and 64 (95% CI 49 to 83) for strontium ranelate. After adjustment for age, Charlson index, and the number of comedications, pulmonary disease in men was associated with an increased use of TES (odds ratio [OR] = 1.48; 95% CI 1.17 to 1.86; p = 0.001). In women, malignant disease (OR = 1.27; 95% CI 1.02 to 1.60; p = 0.04) and pulmonary disease (OR = 1.32; 95% CI 1.07 to 1.62; p = 0.01) were significant predictors at 3 months and rheumatic diseases at 12 months (OR = 1.20; 95% CI 1.10 to 1.31; p < 0.001). There was no significant difference between the different drug classes (bisphosphonates versus nonbisphosphonates, alendronate versus nonalendronate-bisphosphonates) for risk of ocular inflammation, with age and the number of comedications being the only significant predictors. Hospital-treated uveitis (48 patients, or 0.05%) showed a similar trend. In conclusion, after initiation of treatment for osteoporosis, the risk of inflammatory eye reactions requiring TES is relatively low and not significantly different between bisphosphonate and nonbisphosphonate users. Patients with a rheumatic or pulmonary disease are at increased risk.
眼部炎症反应已在接受双膦酸盐治疗的患者中描述过。我们估计在使用基于登记的队列与处方数据（医院和私人诊所）和医院数据相关联来治疗骨质疏松症的患者中，在第 3 个月和第 12 个月时眼部炎症的发生率。从 1997 年 1 月 1 日至 2007 年 12 月 31 日，确定了总共 88202 名开始骨质疏松症治疗的患者。在这些患者中，82404 名（93％）开始口服双膦酸盐，5798 名（7％）未使用双膦酸盐。在治疗的第一年中，有 4769 名（5.4％）接受骨质疏松症治疗的患者开了一种或多种局部眼用类固醇（TES）处方。在骨质疏松症治疗的第一年中，TES 治疗率（每 1000 患者年）为：阿仑膦酸盐 44（95％置信区间[CI]为 42 至 46）；依替膦酸盐 40（95％CI 为 38 至 43）；利塞膦酸盐 45（95％CI 为 35 至 57）；雷洛昔芬 32（95％CI 为 27 至 37）；雷奈酸锶 64（95％CI 为 49 至 83）。在调整年龄，Charlson 指数和用药数量后，男性的肺部疾病与 TES 的使用增加有关（优势比[OR]为 1.48；95％CI 为 1.17 至 1.86；p=0.001）。在女性中，恶性疾病（OR 为 1.27；95％CI 为 1.02 至 1.60；p=0.04）和肺部疾病（OR 为 1.32；95％CI 为 1.07 至 1.62；p=0.01）在第 3 个月是重要的预测因素，而在第 12 个月时风湿性疾病是重要的预测因素（OR 为 1.20；95％CI 为 1.10 至 1.31；p<0.001）。不同药物类别（双膦酸盐与非双膦酸盐，阿仑膦酸盐与非阿仑膦酸盐双膦酸盐）之间眼部炎症的风险没有显著差异，年龄和用药数量是唯一的重要预测因素。在医院治疗的葡萄膜炎（48 例，占 0.05％）也显示出类似的趋势。总之，开始骨质疏松症治疗后，需要 TES 治疗的炎症性眼部反应的风险相对较低，且在双膦酸盐和非双膦酸盐使用者之间无明显差异。患有风湿性或肺部疾病的患者风险增加。
