Faculty of Medicine, McMaster University, Hamilton, ON, Canada,
Arch Osteoporos. 2014;9:169. doi: 10.1007/s11657-013-0169-5. Epub 2014 Feb 28.
We determined the prospective 10-year association among incident fragility fractures and four glucocorticoid (GC) treatment groups (Never GC, Prior GC, Baseline GC, and Ever GC). Results showed that GC treatment is associated with increased 10-year incident fracture risk in ambulatory men and women across Canada.
Using the Canadian Multicentre Osteoporosis Study dataset, we determined the prospective 10-year association between incident fragility fractures and GC treatment.
We conducted a 10-year prospective observational cohort study at nine sites across Canada. A total of 9,263 ambulatory men and women 25 years of age and older were included in the analysis. Multivariable Cox proportional hazards analyses were conducted to determine the relationship among GC treatment groups in four levels that included Never GC, Prior GC, Baseline GC, and Ever GC (combined baseline and prior groups) and time to fracture.
In each of the Never GC, Prior GC, Baseline GC, and Ever GC treatment groups, the number of participants were 8,832 (95.4 %), 303 (3.3 %), 128 (1.4 %), and 431 (4.7 %), respectively. Of the 9,263 individuals enrolled, incident fragility non-spine, hip, spine, and any fractures were experienced by a total of 896 (9.67 %), 157 (1.69 %), 130 (1.40 %), and 1,102 (11.90 %) over 10-years, respectively. For men and women combined, prior GC treatment was associated with a higher hazard ratio (HR) for time to incident non-vertebral (HR = 1.5, 95 % confidence interval [CI] = 1.1, 2.0), hip (HR = 2.1, 95 % CI = 1.1, 4.0), and any fracture (HR = 1.4, 95 % CI = 1.0, 1.8) compared with never GC treatment.
GC treatment is associated with increased 10-year incident fracture risk; this highlights the importance of considering therapy to prevent GC-induced fractures for patients who are using GC for various medical conditions.
使用加拿大骨质疏松多中心研究数据集，我们确定了脆性骨折的发生率与糖皮质激素（GC）治疗之间的 10 年前瞻性关联。
我们在加拿大的九个地点进行了一项为期 10 年的前瞻性观察队列研究。共纳入 9263 名年龄在 25 岁及以上的门诊男性和女性。采用多变量 Cox 比例风险分析来确定 4 个GC 治疗组（从未使用 GC、既往使用 GC、基线时使用 GC 和一直使用 GC[包括基线和既往组]）与骨折时间之间的关系。
在从未使用 GC、既往使用 GC、基线时使用 GC 和一直使用 GC 治疗组中，参与者人数分别为 8832（95.4%）、303（3.3%）、128（1.4%）和 431（4.7%）。在纳入的 9263 名个体中，共有 896 人（9.67%）、157 人（1.69%）、130 人（1.40%）和 1102 人（11.90%）在 10 年内经历了非脊柱、髋部、脊柱和任何部位的脆性骨折。男女合计，既往 GC 治疗与非椎体（HR=1.5，95%置信区间[CI]=1.1，2.0）、髋部（HR=2.1，95%CI=1.1，4.0）和任何部位骨折（HR=1.4，95%CI=1.0，1.8）的发生率较高相关。
GC 治疗与 10 年内发生骨折的风险增加有关；这突出表明，对于因各种医疗条件而使用 GC 的患者，为预防 GC 引起的骨折，考虑进行治疗以预防骨折至关重要。
