Chen C-K, Chang H-T, Chou H-P, Lee M-H, Chen Y-C, Huang Y-C, Chen T-J, Chang H-L, Shih C-C
Department of Radiology, Taipei Veterans General Hospital, No.201, Sec.2, Shipai Rd., Taipei City, 11217, Taiwan.
Osteoporos Int. 2014 Feb;25(2):673-80. doi: 10.1007/s00198-013-2478-3. Epub 2013 Aug 14.
While alendronate inhibits atherosclerosis experimentally, its effect on lower limb ischemia risk is unknown. Our results suggest that alendronate reduces the risk of lower limb ischemic vascular events requiring surgical interventions, including amputation. Our results are relevant for patients at risk of lower limb ischemia undergoing fragility fracture treatment.
This study aimed to determine the association between alendronate therapy and the risk of lower limb ischemic vascular events (i.e., bypass surgery, endovascular stenting, and major lower limb amputation for lower limb ischemia).
We used a nationwide population-based cohort of patients aged over 50 years diagnosed with a vertebral or hip fracture between January 1999 and June 2010. We compared the risk of lower limb ischemic vascular events between patients undergoing treatment with alendronate (n = 3,731) and an age- and sex-matched comparison group (n = 7,462) over 5 years of follow-up. Hazard ratios (HR) were estimated using Cox proportional regression analysis with adjustment for treatment status, comorbidities, and other variables.
Ten patients (0.3 %) in the alendronate treatment group had a lower limb ischemic vascular event compared with 51 patients (0.7 %) in the comparison group. The incidence of lower limb ischemic vascular events was 8.4 (95 % CI, 4.0-15.5) per 10,000 person-years in the alendronate group and 21.8 (95 % CI, 16.2-28.7) per 10,000 person-years in the comparison group. The risk of a lower limb ischemic vascular event in the alendronate treatment group was lower (adjusted HR, 0.41; 95 % CI, 0.21-0.82).
Alendronate treatment was associated with a reduced risk of lower limb ischemic vascular events among hip or vertebral fragility fracture patients.
虽然阿仑膦酸盐在实验中可抑制动脉粥样硬化，但其对下肢缺血风险的影响尚不清楚。我们的研究结果表明，阿仑膦酸盐可降低需要手术干预（包括截肢）的下肢缺血性血管事件的风险。我们的研究结果对于接受脆性骨折治疗且有下肢缺血风险的患者具有重要意义。
本研究旨在确定阿仑膦酸盐治疗与下肢缺血性血管事件（即下肢缺血的搭桥手术、血管内支架置入术和主要下肢截肢术）风险之间的关联。
我们使用了一个基于全国人群的队列，该队列由1999年1月至2010年6月期间诊断为椎体或髋部骨折的50岁以上患者组成。我们比较了接受阿仑膦酸盐治疗的患者（n = 3731）和年龄及性别匹配的对照组（n = 7462）在5年随访期间发生下肢缺血性血管事件的风险。使用Cox比例回归分析估计风险比（HR），并对治疗状态、合并症和其他变量进行调整。
阿仑膦酸盐治疗组中有10名患者（0.3%）发生下肢缺血性血管事件，而对照组中有51名患者（0.7%）发生。阿仑膦酸盐组下肢缺血性血管事件的发生率为每10000人年8.4例（95%CI，4.0 - 15.5），对照组为每10000人年21.8例（95%CI，16.2 - 28.7）。阿仑膦酸盐治疗组发生下肢缺血性血管事件的风险较低（调整后HR，0.41；95%CI，0.21 - 0.82）。
阿仑膦酸盐治疗与髋部或椎体脆性骨折患者下肢缺血性血管事件风险降低有关。
