一项病例对照研究中老年人口服糖皮质激素的使用与髋部骨折风险

Use of Oral Corticosteroids and Risk of Hip Fracture in the Elderly in a Case-Control Study.

作者信息

Lai Shih-Wei, Lin Cheng-Li, Liao Kuan-Fu

机构信息

College of Medicine, China Medical UniversityTaichung, Taiwan.

Department of Family Medicine, China Medical University HospitalTaichung, Taiwan.

出版信息

Front Pharmacol. 2017 Sep 11;8:625. doi: 10.3389/fphar.2017.00625. eCollection 2017.

Abstract

Little is known regarding the relationship between use of oral corticosteroids and hip fracture in the elderly in Taiwan. The aim of the study was to examine this issue. A retrospective population-based case-control study using the database of the Taiwan National Health Insurance Program (2000-2013) was conducted. We identified 4538 individuals aged ≥ 65 years with newly diagnosed hip fracture as the cases. We randomly selected 4538 individuals without hip fracture as the control subjects. The cases and the control subjects were matched with sex, age, comorbidities, and the year of index date. Individuals who never had a prescription for oral corticosteroids were defined as never use. Individuals who ever had at least one prescription for oral corticosteroids were defined as ever use. The odds ratio (OR) and 95% confidence interval (CI) of hip fracture associated with oral corticosteroids use was estimated by a multivariable unconditional logistic regression analysis. After adjustments for potential confounding factors, the multivariable logistic regression model showed that the adjusted OR of hip fracture was 1.17 for individuals with ever use of oral corticosteroids (95%CI 1.08, 1.28), compared to those with never use of oral corticosteroids. An sub-analysis showed that for every 1-mg increase in cumulative dose of oral corticosteroids, the adjusted OR of hip fracture was 1.01 (95% CI 1.01, 1.02). The adjusted ORs were 1.31 (95% CI 1.17, 1.47) for cumulative exposure to oral corticosteroids ≥ 3 months and 1.09 (95% CI 0.98, 1.20) for cumulative exposure < 3 months. We conclude that oral corticosteroids use is associated with a trivial but statistically significant increase in risk of hip fracture in Taiwan. Additionally, the results suggest that there are dose-response and duration-response effects of oral corticosteroids on the risk of hip fracture. The results confirm our understanding of oral corticosteroid-associated hip fracture in the elderly.

摘要

关于台湾老年人使用口服皮质类固醇与髋部骨折之间的关系,人们知之甚少。本研究的目的是探讨这一问题。我们利用台湾国民健康保险计划(2000 - 2013年)的数据库进行了一项基于人群的回顾性病例对照研究。我们确定了4538名年龄≥65岁且新诊断为髋部骨折的个体作为病例组。我们随机选择了4538名无髋部骨折的个体作为对照组。病例组和对照组在性别、年龄、合并症以及索引日期年份方面进行了匹配。从未开具过口服皮质类固醇处方的个体被定义为从未使用过。曾经至少有一次口服皮质类固醇处方的个体被定义为曾经使用过。通过多变量无条件逻辑回归分析估计与使用口服皮质类固醇相关的髋部骨折的比值比(OR)和95%置信区间(CI)。在对潜在混杂因素进行调整后,多变量逻辑回归模型显示,与从未使用口服皮质类固醇的个体相比,曾经使用过口服皮质类固醇的个体髋部骨折的调整后OR为1.17(95%CI 1.08,1.28)。一项亚分析显示,口服皮质类固醇累积剂量每增加1毫克,髋部骨折的调整后OR为1.01(95%CI 1.01,1.02)。口服皮质类固醇累积暴露≥3个月的调整后OR为1.31(95%CI 1.17,1.47),累积暴露<3个月的调整后OR为1.09(95%CI 0.98,1.20)。我们得出结论,在台湾,使用口服皮质类固醇与髋部骨折风险虽微小但在统计学上有显著增加相关。此外,结果表明口服皮质类固醇对髋部骨折风险存在剂量反应和持续时间反应效应。这些结果证实了我们对老年人中与口服皮质类固醇相关的髋部骨折的认识。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e41/5600992/100876095aa9/fphar-08-00625-g001.jpg

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