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台湾一项病例对照研究中噻唑烷二酮类药物的使用与老年人髋部骨折风险

Use of thiazolidinediones and risk of hip fracture in old people in a case-control study in Taiwan.

作者信息

Lin Hsien-Feng, Liao Kuan-Fu, Chang Ching-Mei, Lin Cheng-Li, Lin Chih-Hsueh, Lai Shih-Wei

机构信息

School of Chinese Medicine Department of Family Medicine, China Medical University Hospital, Taichung Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung College of Medicine, Tzu Chi University, Hualien Graduate Institute of Integrated Medicine, China Medical University Hospital, Taichung Department of Nursing, Tungs Taichung Metro Harbor Hospital, Taichung College of Medicine, China Medical University, Taichung Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.

出版信息

Medicine (Baltimore). 2017 Sep;96(36):e7712. doi: 10.1097/MD.0000000000007712.

Abstract

Little research is available on the association between use of thiazolidinediones and hip fracture in old people in Taiwan. We conducted a population-based case-control study to examine this issue.Using the database of the Taiwan National Health Insurance Program, we identified 603 type 2 diabetic subjects 65 years or older in age with newly diagnosed hip fracture in 2000 to 2013 as cases. We randomly selected 603 type 2 diabetic subjects 65 years or older without hip fracture as the controls. Both cases and controls were matched with sex, age, comorbidities, and index year of diagnosing hip fracture. Current use of thiazolidinediones was defined as subjects whose last remaining one tablet of thiazolidinediones was noted ≤30 days before the date of diagnosing hip fracture. Never use of thiazolidinediones was defined as subjects who never had a prescription of thiazolidinediones. The odds ratio (OR) and 95% confidence interval (CI) for hip fracture associated with thiazolidinediones use was estimated by the multivariable unconditional logistic regression analysis.After adjustment for covariables, the multivariable logistic regression analysis revealed that the adjusted OR of hip fracture was 1.64 for subjects with current use of thiazolidinediones (95% CI 1.01, 2.67), when compared with subjects with never use of thiazolidinediones.Our findings suggest that current use of thiazolidinediones is associated with a 64% higher risk of hip fracture in type 2 diabetic old people in Taiwan. Clinicians should consider the possibility of thiazolidinediones-associated hip fracture among type 2 diabetic old people currently using thiazolidinediones.

摘要

关于台湾老年人使用噻唑烷二酮类药物与髋部骨折之间的关联,现有研究较少。我们开展了一项基于人群的病例对照研究来探讨这一问题。利用台湾全民健康保险计划的数据库,我们将2000年至2013年新诊断为髋部骨折的603名65岁及以上的2型糖尿病患者确定为病例组。我们随机选取603名65岁及以上无髋部骨折的2型糖尿病患者作为对照组。病例组和对照组在性别、年龄、合并症以及髋部骨折诊断的索引年份方面进行了匹配。当前使用噻唑烷二酮类药物定义为在诊断髋部骨折日期前≤30天记录有最后一片剩余噻唑烷二酮类药物的受试者。从未使用噻唑烷二酮类药物定义为从未有过噻唑烷二酮类药物处方的受试者。通过多变量无条件逻辑回归分析估计与使用噻唑烷二酮类药物相关的髋部骨折的比值比(OR)和95%置信区间(CI)。在对协变量进行调整后,多变量逻辑回归分析显示,与从未使用噻唑烷二酮类药物的受试者相比,当前使用噻唑烷二酮类药物的受试者髋部骨折的调整后OR为1.64(95%CI 1.01,2.67)。我们的研究结果表明,在台湾2型糖尿病老年人中,当前使用噻唑烷二酮类药物与髋部骨折风险高64%相关。临床医生应考虑目前正在使用噻唑烷二酮类药物的2型糖尿病老年人发生噻唑烷二酮类药物相关髋部骨折的可能性。

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