Leach Michael J, Pratt Nicole L, Roughead Elizabeth E
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
Pharmacoepidemiol Drug Saf. 2015 Jun;24(6):576-82. doi: 10.1002/pds.3785. Epub 2015 Apr 16.
Many factors can increase the risk of hip fracture, including medicines. Traditional observational studies have assessed the risk, but results may be confounded by unmeasured factors. The case-crossover design is an alternative approach that controls for patient-specific, time-invariant confounding factors. This study aimed to assess associations between psychoactive medicines and hip fracture in the elderly using the case-crossover method.
Data were sourced from the Australian Government Department of Veterans' Affairs healthcare claims database. The study population comprised beneficiaries aged over 65 years who were hospitalised for hip fracture between 2009 and 2012. The case-crossover method was used to compare individuals' medicine exposure immediately before hip fracture (case window) with their exposure at an earlier time (control window). Conditional logistic regression was employed to quantify associations between medicine use and hip fracture. Alternative exposure windows were assessed in sensitivity analyses.
Eight thousand eight hundred twenty-eight patients were hospitalised for hip fracture. Their median age was 88 years, and 63% were female. Odds of hip fracture were increased for opioids (odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.42-1.84), selective serotonin reuptake inhibitors (OR = 1.54, 95% CI = 1.28-1.86) and antipsychotics (OR = 1.47, 95% CI = 1.21-1.80). There was no significant association for tricyclic antidepressants in the primary analysis (OR = 1.18, 95% CI = 0.91-1.52), but there was a significant association in the sensitivity analysis using an alternative, earlier control window (OR = 1.43, 95% CI = 1.11-1.83).
Increased risk of hip fracture in older people was found for opioids, selective serotonin reuptake inhibitors and antipsychotics. The choice of control window influenced the result for tricyclic antidepressants.
许多因素会增加髋部骨折风险，包括药物。传统观察性研究已评估了这种风险，但结果可能会受到未测量因素的混淆。病例交叉设计是一种控制个体特定、时间不变混杂因素的替代方法。本研究旨在采用病例交叉法评估精神活性药物与老年人髋部骨折之间的关联。
数据来源于澳大利亚政府退伍军人事务部医疗保健索赔数据库。研究人群包括2009年至2012年间因髋部骨折住院的65岁以上受益人。病例交叉法用于比较个体在髋部骨折前即刻（病例窗口）的药物暴露情况与其在更早时间（对照窗口）的暴露情况。采用条件逻辑回归来量化药物使用与髋部骨折之间的关联。在敏感性分析中评估了替代暴露窗口。
8828名患者因髋部骨折住院。他们的中位年龄为88岁，63%为女性。阿片类药物（比值比[OR]=1.62，95%置信区间[CI]=1.42 - 1.84）、选择性5-羟色胺再摄取抑制剂（OR = 1.54，95% CI = 1.28 - 1.86）和抗精神病药物（OR = 1.47，95% CI = 1.21 - 1.80）使髋部骨折几率增加。在主要分析中，三环类抗抑郁药无显著关联（OR = 1.18，95% CI = 0.91 - 1.52），但在使用替代的更早对照窗口的敏感性分析中有显著关联（OR = 1.43，95% CI = 1.11 - 1.83）。
发现阿片类药物、选择性5-羟色胺再摄取抑制剂和抗精神病药物会增加老年人髋部骨折风险。对照窗口的选择影响了三环类抗抑郁药的结果。
