调查 2 型糖尿病老年患者骨折风险：一项回顾性研究。
Investigating the risk of bone fractures in elderly patients with type 2 diabetes mellitus: a retrospective study.
机构信息
Division of Clinical Pharmacy (Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, 1-15-1 Kitasato, Minami Ward, Sagamihara City, Kanagawa Prefecture, 252-0375, Japan.
Division of Clinical Pharmacy (Laboratory of Drug Information) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, 1-15-1 Kitasato, Minami Ward, Sagamihara City, Kanagawa Prefecture, 252-0375, Japan.
出版信息
BMC Endocr Disord. 2019 Jul 26;19(1):81. doi: 10.1186/s12902-019-0413-0.
BACKGROUND
Elderly patients with type 2 diabetes mellitus (T2DM) experience fractures more frequently than elderly individuals without diabetes. Fractures requiring hospitalization greatly affect quality of life, and although elderly patients with T2DM have several risk factors associated with fractures, only a few studies have evaluated these in detail in the Asian population. We conducted a retrospective study of elderly patients with T2DM for evaluating factors associated with fracture risk.
METHODS
We conducted a retrospective study using electronic medical records (EMR) of patients aged ≥65 years with T2DM who were admitted to a public general medical institute in central Tokyo, Japan. We evaluated factors associated with fractures necessitating hospitalization in elderly patients with T2DM characteristics and hypoglycemic agent use. Factors associated with fracture risk were identified using multivariable logistic regression analysis.
RESULTS
A total of 2,112 elderly patients (age ≥ 65 years) with T2DM were analyzed. Among them, 69 (3.3%) patients had been hospitalized for fractures. Factors associated with fractures were female sex (OR, 3.46), eGFR < 60 ml / min / 1.73 m (OR, 0.55), and thiazolidine use (OR, 4.28). Further, a separate analysis based on sex revealed that the use of thiazolidines was significantly associated with fracture risk in both sexes.
CONCLUSIONS
In elderly patients with T2DM, the key factor associated with fractures was the use of thiazolidines in both males and females. In this study, the use of thiazolidines was newly identified as a factor which increased the risk of fractures requiring hospitalization in elderly males. The study findings should be considered when hypoglycemic agents are selected for treating elderly patients with T2DM. Information bias, selection bias, and the effect of concomitant drugs may be the underlying reasons for why eGFR < 60 mL / min / 1.73 m reduced the fracture risk. However, details are unknown, and additional investigations are needed.
背景
老年 2 型糖尿病（T2DM）患者比非糖尿病老年患者更容易发生骨折。需要住院治疗的骨折会极大地影响生活质量，尽管老年 T2DM 患者存在与骨折相关的多种风险因素，但只有少数研究详细评估了亚洲人群中的这些因素。我们对老年 T2DM 患者进行了回顾性研究，以评估与骨折风险相关的因素。
方法
我们使用日本东京市中心一家公立综合医学研究所的电子病历（EMR）对年龄≥65 岁的 T2DM 患者进行了回顾性研究。我们评估了老年 T2DM 患者骨折风险的相关因素与骨折特征和降糖药物使用的关系。使用多变量逻辑回归分析确定与骨折风险相关的因素。
结果
共分析了 2112 名年龄≥65 岁的老年 T2DM 患者。其中，69 名（3.3%）患者因骨折住院。与骨折相关的因素为女性（OR，3.46）、eGFR <60ml / min / 1.73m（OR，0.55）和噻唑烷二酮类药物的使用（OR，4.28）。此外，基于性别的单独分析显示，噻唑烷二酮类药物的使用与两性的骨折风险均显著相关。
结论
在老年 T2DM 患者中，与骨折相关的关键因素是男女两性均使用噻唑烷二酮类药物。在这项研究中，噻唑烷二酮类药物的使用被新确定为增加老年男性骨折住院风险的因素。在选择治疗老年 T2DM 患者的降糖药物时，应考虑这些研究结果。信息偏倚、选择偏倚和伴随药物的影响可能是 eGFR <60ml / min / 1.73m 降低骨折风险的根本原因。但是，具体细节尚不清楚，还需要进一步研究。
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