避免骨折风险的同时不影响大脑 - 双膦酸盐与中风风险：匹配病例对照研究。
Saving bones without risking brain-bisphosphonates and risk of stroke: matched case-control study.
机构信息
Mathematical Modelling and Statistics, Community and Health Research Unit, School of Health and Social Care, College of Social Science, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK.
Community and Health Research Unit, School of Health and Social Care, College of Social Science, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK.
出版信息
Osteoporos Int. 2019 Sep;30(9):1845-1854. doi: 10.1007/s00198-019-05045-z. Epub 2019 Jun 17.
UNLABELLED
We investigated the association between bisphosphonate treatment and the risk of stroke using a large routine clinical dataset. We found no association between bisphosphonate treatment and risk of stroke, after adjusting for large number of clinical and demographic confounders.
INTRODUCTION
There is conflicting evidence on the link between bisphosphonates and stroke with studies variously showing increased, decreased or unchanged risk. We investigated the association between bisphosphonate treatment and the risk of stroke using a large routine clinical dataset.
METHODS
We used a matched nested case-control study design analysing routinely collected electronic data from patients registered at primary care practices in England participating in the Royal College of General Practitioners Research and Surveillance Centre. Cases were patients aged 18 years or over, either living or dead, recorded as having had a stroke in the period 1 January 2005 to 31 March 2016. Each case was matched to one control according to age, sex, general practice attended and calendar time. Data were analysed using Stata, version 14.2. and RStudio, version 1.1.463. Conditional logistic regression was used to determine odds ratios for stroke according to bisphosphonate treatment and duration in cases compared with controls. We adjusted for disease risk groups, cardiovascular risk factors, treatments, smoking status, alcohol consumption, ethnicity, bisphosphonate types, fracture and socioeconomic status using IMD (Index of Multiple Deprivation).
RESULTS
We included 31,414 cases of stroke with an equal number of matched controls. Overall, 83.2% of cases and controls were aged 65 years or older, and there were similar proportions of females (51.5%) and males (48.5%). Bisphosphonate treatment was not associated with stroke after adjusting for the wide range of confounders considered (OR 0.86, 95% CI 0.62-1.19).
CONCLUSIONS
We found no association between bisphosphonate treatment and risk of stroke, after adjusting for other confounders.
目的
使用大型常规临床数据集研究双膦酸盐治疗与中风风险之间的关联。方法：我们采用匹配的巢式病例对照研究设计，分析了英格兰初级保健实践中参加皇家全科医生研究和监测中心的患者常规收集的电子数据。病例为年龄在 18 岁或以上的患者，无论其是否存活，均记录为在 2005 年 1 月 1 日至 2016 年 3 月 31 日期间患有中风。每个病例根据年龄、性别、就诊的全科医生和日历时间与一名对照匹配。使用 Stata 版本 14.2 和 RStudio 版本 1.1.463 进行数据分析。使用条件逻辑回归确定病例中与对照相比，双膦酸盐治疗和持续时间与中风的比值比。我们使用 IMD（多因素剥夺指数）调整了疾病风险组、心血管危险因素、治疗、吸烟状况、饮酒状况、种族、双膦酸盐类型、骨折和社会经济状况等因素。结果：我们纳入了 31414 例中风病例，并有同等数量的匹配对照。总体而言，83.2%的病例和对照年龄在 65 岁或以上，女性（51.5%）和男性（48.5%）的比例相似。在调整了广泛考虑的混杂因素后，双膦酸盐治疗与中风之间没有关联（OR 0.86，95%CI 0.62-1.19）。结论：在调整了其他混杂因素后，我们发现双膦酸盐治疗与中风风险之间没有关联。
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