不同双膦酸盐类药物的死亡率降低效果不同：一项长达 15 年的观察性研究。
Mortality risk reduction differs according to bisphosphonate class: a 15-year observational study.
机构信息
Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
Maastricht University Medical Center, Research School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands.
出版信息
Osteoporos Int. 2019 Apr;30(4):817-828. doi: 10.1007/s00198-018-4806-0. Epub 2019 Jan 3.
UNLABELLED
In this prospective cohort of 6120 participants aged 50+, nitrogen-bisphosphonates but not non-nitrogen bisphosphonates were associated with a significant 34% mortality risk reduction compared to non-treated propensity score matched controls. These findings open new avenues for research into mechanistic pathways.
INTRODUCTION
Emerging evidence suggests that bisphosphonates (BP), first-line treatment of osteoporosis, are associated with reduced risks for all-cause mortality. This study aimed to determine the association between different BP types and mortality risk in participants with or without a fracture.
METHODS
A prospective cohort study of users of different BPs matched to non-users by propensity score (age, gender, co-morbidities, fragility fracture status) and time to starting the BP medication from the population-based Canadian Multicentre Osteoporosis Study from nine Canadian centres followed from 1995 to 2013. Mortality risk for bisphosphonate users vs matched non-users was assessed using pairwise multivariable Cox proportional hazards models.
RESULTS
There were 2048 women and 308 men on BP and 1970 women and 1794 men who did not receive medication for osteoporosis. The relationship between BP and mortality risk was explored in three separate 1:1 propensity score-matched cohorts of BP users and no treatment (etidronate, n = 599, alendronate, n = 498, and risedronate n = 213). Nitrogen BP (n-BP) (alendronate and risedronate) was associated with lower mortality risks [pairwise HR, 0.66 (95% CI, 0.48-0.91)] while the less potent non-n-BP, etidronate, was not [pairwise HR: 0.89 (95% CI, 0.66-1.20)]. A direct comparison between n-BP and etidronate (n = 340 pairs) also suggested a better survival for n-BP [paired HR, 0.47 (95%CI, (95% CI, 031-0.70)] for n-BP vs. etidronate].
CONCLUSION
Compared to no treatment, nitrogen but not non-nitrogen bisphosphonates appear to be associated with better survival.
未注明
在这项针对 6120 名 50 岁以上参与者的前瞻性队列研究中，与未接受倾向评分匹配对照治疗的患者相比，氮双膦酸盐而非非氮双膦酸盐与显著降低 34%的死亡率风险相关。这些发现为研究机制途径开辟了新的途径。
简介
新出现的证据表明，双膦酸盐（BP），骨质疏松症的一线治疗药物，与全因死亡率降低相关。本研究旨在确定不同 BP 类型与骨折患者和无骨折患者的死亡率风险之间的关系。
方法
这项前瞻性队列研究纳入了来自加拿大 9 个中心的加拿大多中心骨质疏松症研究中的不同 BP 使用者，并按倾向评分（年龄、性别、合并症、脆性骨折状态）和开始 BP 药物治疗的时间与非使用者进行匹配，随访时间从 1995 年至 2013 年。使用配对多变量 Cox 比例风险模型评估 BP 使用者与匹配非使用者的死亡率风险。
结果
有 2048 名女性和 308 名男性接受 BP 治疗，1970 名女性和 1794 名男性未接受骨质疏松症药物治疗。在三个单独的 1:1 倾向评分匹配 BP 使用者和无治疗（依替膦酸盐、n=599；阿仑膦酸盐、n=498；利塞膦酸盐、n=213）队列中，探讨了 BP 与死亡率风险之间的关系。氮双膦酸盐（n-BP）（阿仑膦酸盐和利塞膦酸盐）与较低的死亡率风险相关（配对 HR，0.66（95%CI，0.48-0.91）），而效力较弱的非氮双膦酸盐，依替膦酸盐，不相关（配对 HR：0.89（95%CI，0.66-1.20））。n-BP 与依替膦酸盐（n=340 对）的直接比较也表明 n-BP 的生存情况更好[配对 HR，0.47（95%CI，0.31-0.70）]与依替膦酸盐相比，n-BP 对 n-BP]。
结论
与无治疗相比，氮双膦酸盐而非非氮双膦酸盐似乎与更好的生存相关。
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