Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands.
NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands.
Osteoporos Int. 2019 Mar;30(3):573-581. doi: 10.1007/s00198-019-04851-9. Epub 2019 Feb 8.
In the first year, after an osteoporotic fracture of a hip, forearm, upper arm, or spine, the dispensing rates of antidepressants and benzodiazepines increased significantly. After those fractures, recent and past use of antidepressants and benzodiazepines was associated with increased all-cause mortality; current use was not associated with mortality risk.
It remains unclear to what extent use of antidepressants and benzodiazepines is associated with mortality risk after a major osteoporotic fracture (MOF). We aimed to study the cumulative use of antidepressants and benzodiazepines during the year after MOF or hip fracture (HF) and whether the use was associated with mortality.
A cohort study was performed within the Dutch PHARMO Database Network including all patients aged 65+ with a first record of MOF (hip, humerus, forearm, and clinical vertebral fracture) between 2002 and 2011. Data were analyzed using Cox regression models, adjusted for comorbidities, and concomitant medication use and broken down to index fracture type.
A total of 4854 patients sustained a first MOF, of whom 1766 patients sustained a HF. Mean follow-up was 4.6 years, divided in 30-day periods. The cumulative antidepressant and benzodiazepine use during the first year after MOF increased from 10.6 to 14.7% and from 24.0 to 31.4%, respectively. Recent (31-92 days before each follow-up period) and past use (> 92 days before) of antidepressants and benzodiazepines after MOF or HF was associated with an increased all-cause mortality risk but current use (< 30 days before) was not.
There is a considerable increase in dispensing rate of antidepressants and benzodiazepines in the first year after a MOF. Recent and past use of these medications was associated with all-cause mortality. The finding that current use was not associated with mortality should be further explored and may probably be explained by the healthy survivor's bias.
髋部、前臂、上臂或脊柱骨质疏松性骨折后 1 年内，抗抑郁药和苯二氮䓬类药物的配药率显著增加。这些骨折后，近期和既往使用抗抑郁药和苯二氮䓬类药物与全因死亡率增加相关；而当前使用与死亡率风险无关。
髋部骨折（HF）或骨质疏松性骨折（MOF）后使用抗抑郁药和苯二氮䓬类药物与死亡率风险的关系程度仍不清楚。我们旨在研究 MOF 或 HF 后 1 年内抗抑郁药和苯二氮䓬类药物的累积使用情况，以及该使用是否与死亡率相关。
该研究为荷兰 PHARMO 数据库网络中的一项队列研究，纳入了 2002 年至 2011 年间首次记录的 MOF（髋部、肱骨、前臂和临床椎体骨折）的所有 65 岁以上患者。使用 Cox 回归模型分析数据，调整了合并症和同时使用的药物，并按索引骨折类型进行了细分。
共有 4854 例患者发生了首次 MOF，其中 1766 例患者发生了 HF。平均随访时间为 4.6 年，分为 30 天期。MOF 后第一年抗抑郁药和苯二氮䓬类药物的累积使用量分别从 10.6%增加到 14.7%和从 24.0%增加到 31.4%。MOF 或 HF 后近期（每个随访期前 31-92 天）和既往使用（>92 天前）抗抑郁药和苯二氮䓬类药物与全因死亡率风险增加相关，但当前使用（<30 天前）则不然。
MOF 后第一年抗抑郁药和苯二氮䓬类药物的配药率显著增加。这些药物的近期和既往使用与全因死亡率相关。当前使用与死亡率无关的发现尚需进一步探讨，可能可以用健康幸存者的偏倚来解释。
