College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, South Korea.
Major in Statistics and Data Science, Daegu University, Gyeongsan-si, Gyeongbuk, 38453, South Korea.
Clin Drug Investig. 2019 Jan;39(1):63-71. doi: 10.1007/s40261-018-0716-3.
Polypharmacy, regarded as an indicator of potentially inappropriate medications (PIMs), may lead to a higher risk of serious health consequences in elderly patients with osteoporosis. Thus, this study aimed to analyze the association between polypharmacy and hip fracture in patients with osteoporosis because only a limited number of studies have reported on this association, with inconsistent results to date.
In this nested case-control study using a population-based sample cohort, the target cases were female patients with hip fracture diagnosed with osteoporosis and aged ≥ 50 years. Polypharmacy (prescription of an average of five or more daily drugs), PIMs for hip fracture (such as benzodiazepines and glucocorticoids), Charlson Comorbidity Index (CCI) score, and other comorbidities were analyzed during the year preceding the diagnosis of hip fracture. Adjusted odds ratios (ORs) for hip fracture for the variables were also analyzed.
The cases (n = 1003) showed higher exposure rates to polypharmacy, glucocorticoids, and benzodiazepines, and had more severe comorbidity statuses compared with the controls. The ORs for hip fracture adjusted for confounders increased with polypharmacy level, with persistent statistical significance in most analyses. The ORs (95% confidence intervals), with reference to the 0 to < 1 drug group, were 1.65 (1.31-2.08) and 2.11 (1.12-3.96) for the 5 to < 10 and 10 + drug groups, respectively, with adjustment for PIMs, and 1.34 (1.04-1.72) and 1.45 (0.76-2.80) for the 5 to < 10 and 10 + drug groups, respectively, with adjustment for PIMs and CCI score.
The results suggest that polypharmacy is associated with an increased risk of hip fracture after adjustment for confounders in patients with osteoporosis. These results highlight the importance of polypharmacy management in preventing hip fractures in patients with osteoporosis.
多种药物治疗被认为是潜在不适当药物（PIMs）的指标，可能会增加老年骨质疏松症患者发生严重健康后果的风险。因此，本研究旨在分析骨质疏松症患者中多种药物治疗与髋部骨折之间的关联，因为迄今为止，只有少数研究报告了这种关联，结果不一致。
本研究使用基于人群的样本队列进行嵌套病例对照研究，将目标病例确定为诊断为骨质疏松症且年龄≥50 岁的女性髋部骨折患者。在诊断髋部骨折前一年分析了多种药物治疗（平均每天处方五种或更多种药物）、髋部骨折的 PIM（如苯二氮䓬类和糖皮质激素）、Charlson 合并症指数（CCI）评分和其他合并症。还分析了髋部骨折的变量调整后比值比（OR）。
病例组（n=1003）在多种药物治疗、糖皮质激素和苯二氮䓬类药物的暴露率更高，且合并症严重程度更高。调整混杂因素后，髋部骨折的 OR 随着多种药物治疗水平的增加而增加，在大多数分析中均具有统计学意义。与 0 至<1 种药物组相比，调整 PIM 后，5 至<10 种和 10+种药物组的 OR（95%置信区间）分别为 1.65（1.31-2.08）和 2.11（1.12-3.96），调整 PIM 和 CCI 评分后，5 至<10 种和 10+种药物组的 OR 分别为 1.34（1.04-1.72）和 1.45（0.76-2.80）。
结果表明，调整骨质疏松症患者的混杂因素后，多种药物治疗与髋部骨折风险增加相关。这些结果强调了在骨质疏松症患者中管理多种药物治疗以预防髋部骨折的重要性。
