Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Clinical Pharmacy, Atrium Medical Centre, Heerlen, The Netherlands.
Bone. 2018 May;110:238-243. doi: 10.1016/j.bone.2018.02.007. Epub 2018 Feb 17.
Chronic obstructive pulmonary disease (COPD) is characterised by persistent airflow obstruction and respiratory symptoms. While short course systemic GCs are prescribed in patients with acute COPD exacerbations, little is known of the risk of fractures with intermittent exposure to high-dose GC and the effect of proxies of disease severity.
A case-control study was conducted using the Danish National Hospital Discharge Registry (NHDR) between January 1996 to December 2011. Conditional logistics regression models were used to derive adjusted odds ratios (OR) risk of fractures in subjects with COPD stratified by intermittent high-dose, and proxies of disease severity.
A total of 635,536 cases and the same number of controls were identified (mean age 67.5±13.8, 65% female). COPD patients with intermittent use of high average daily dose oral glucocorticoids did not have an increased risk of any, osteoporotic, hip or clinically symptomatic vertebral fracture compared to non-COPD patients (adj. OR 0.65; 95% CI: 0.50-0.86, 0.70; 95% CI: 0.70-0.99, 1.17; 95% CI: 0.59-2.32, 1.98; 95% CI: 0.59-6.65 respectively). We identified an elevated risk of osteoporotic fracture among patients who visited the emergency unit (adj. OR 1.47; 95% CI 1.20-1.79) or were hospitalised in the past year for COPD (adj. OR 1.76; 95% CI 1.66-1.85). Current GC use among COPD patients was associated with an increased risk of osteoporotic, hip and clinically symptomatic vertebral fractures compared to patients without COPD.
Intermittent high-dose GCs was not associated with an increased risk of any, osteoporotic, hip or clinically symptomatic vertebral fractures in patients with COPD. Current GC use was however associated with an increased risk of hip and clinically symptomatic vertebral fractures. Therefore, emphasis on prophylactic treatment of fractures may not be essential in patients with COPD receiving intermittent dose of GCs, whereas this should be considered for high-dose long-term users with advanced COPD disease stage, postmenopausal women and men over 40years.
慢性阻塞性肺疾病（COPD）的特征是持续性气流阻塞和呼吸道症状。虽然在急性 COPD 加重的患者中会短期使用全身糖皮质激素（GC），但对于间歇性暴露于高剂量 GC 与疾病严重程度指标的骨折风险知之甚少。
本研究采用丹麦全国住院患者登记系统（NHDR），对 1996 年 1 月至 2011 年 12 月间的 COPD 患者进行病例对照研究。采用条件逻辑回归模型得出 COPD 患者骨折风险的调整比值比（OR），该患者组按间歇性高剂量和疾病严重程度指标分层。
共纳入 635536 例 COPD 患者病例和相同数量的对照（平均年龄 67.5±13.8 岁，65%为女性）。与非 COPD 患者相比，间歇性使用高平均日剂量口服糖皮质激素的 COPD 患者并未增加任何、骨质疏松性、髋部或临床症状性椎体骨折的风险（调整 OR 0.65；95%CI：0.50-0.86，0.70；95%CI：0.70-0.99，1.17；95%CI：0.59-2.32，1.98；95%CI：0.59-6.65）。我们发现，在过去一年中因 COPD 就诊急诊（调整 OR 1.47；95%CI 1.20-1.79）或住院（调整 OR 1.76；95%CI 1.66-1.85）的患者中，骨质疏松性骨折风险升高。与无 COPD 患者相比，目前正在使用 GC 的 COPD 患者的骨质疏松性、髋部和临床症状性椎体骨折风险增加。
间歇性高剂量 GC 与 COPD 患者的任何、骨质疏松性、髋部或临床症状性椎体骨折风险增加无关。然而，目前正在使用 GC 与髋部和临床症状性椎体骨折风险增加有关。因此，对于接受间歇性剂量 GC 治疗的 COPD 患者，强调骨折的预防性治疗可能不是必要的，而对于疾病严重程度高的晚期 COPD 患者、绝经后妇女和 40 岁以上男性，则应考虑这一点。
