Roddy Edward, Muller Sara, Paskins Zoe, Hider Samantha L, Blagojevic-Bucknall Milisa, Mallen Christian D
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.
Medicine (Baltimore). 2017 Mar;96(12):e6177. doi: 10.1097/MD.0000000000006177.
Oral bisphosphonates are the most commonly used drugs to treat postmenopausal osteoporosis. Acute pseudogout is anecdotally reported to occur following bisphosphonate initiation but empirical data are lacking. We investigated whether treatment with oral bisphosphonates is a risk factor for incident acute pseudogout.A matched case-control study was undertaken using data from the UK-Clinical Practice Research Datalink. Adults who consulted for incident acute pseudogout between 1987 and 2012 were each matched for gender, age at pseudogout diagnosis, and general practice to up to 4 control subjects without pseudogout. The exposure of interest was a prescription for an oral bisphosphonate issued within the 60-day period prior to the date of incident acute pseudogout. Associations between incident acute pseudogout and prior bisphosphonate prescription were examined using conditional logistic regression, adjusting for hyperparathyroidism, osteoarthritis, rheumatoid arthritis, hemochromatosis, hypophosphatasia, and prescriptions for diuretics and oral corticosteroids.Two thousand eleven acute pseudogout cases were compared with 8013 matched controls without acute pseudogout (mean age [standard deviation] 72 years [14]; 52% male). One hundred twenty-three cases (6.1%) had received an oral bisphosphonate prescription in the 60-day exposure period compared with 305 controls (3.8%) (adjusted incidence rate ratio [IRR] 1.33; 95% confidence interval [CI] 1.05-1.69). This association was stronger in females (adjusted IRR 1.49; 95% CI 1.15-1.94) and was nonsignificant in males (0.83; 0.48-1.44).Incident acute pseudogout was associated with prescription of an oral bisphosphonate in the preceding 60 days. Prescribers should be aware of acute pseudogout as a possible side effect of bisphosphonate treatment. Further research is needed to explore the risks conferred by different bisphosphonates and the mechanism underlying this association.
口服双膦酸盐是治疗绝经后骨质疏松症最常用的药物。据传闻，双膦酸盐开始使用后会发生急性假性痛风，但缺乏实证数据。我们调查了口服双膦酸盐治疗是否是新发急性假性痛风的危险因素。
我们利用英国临床实践研究数据链的数据进行了一项匹配病例对照研究。1987年至2012年间因新发急性假性痛风就诊的成年人，根据性别、假性痛风诊断时的年龄以及普通科，与多达4名无假性痛风的对照受试者进行匹配。感兴趣的暴露因素是在新发急性假性痛风日期前60天内开具的口服双膦酸盐处方。使用条件逻辑回归分析新发急性假性痛风与先前双膦酸盐处方之间的关联，并对甲状旁腺功能亢进、骨关节炎、类风湿关节炎、血色素沉着症、低磷酸酯酶症以及利尿剂和口服糖皮质激素的处方进行校正。
2111例急性假性痛风病例与8013名匹配的无急性假性痛风对照者（平均年龄[标准差]72岁[14]；52%为男性）进行了比较。123例病例（6.1%）在60天暴露期内接受了口服双膦酸盐处方，而对照者为305例（3.8%）（校正发病率比[IRR]1.33；95%置信区间[CI]1.05 - 1.69）。这种关联在女性中更强（校正IRR 1.49；95% CI 1.15 - 1.94），在男性中无统计学意义（0.83；0.48 - 1.44）。
新发急性假性痛风与前60天内口服双膦酸盐处方有关。处方医生应意识到急性假性痛风是双膦酸盐治疗可能的副作用。需要进一步研究以探讨不同双膦酸盐带来的风险以及这种关联的潜在机制。
