阿仑膦酸盐药物持有率与第二次髋部骨折风险：一项基于台湾人群的11年队列研究。

Alendronate medication possession ratio and the risk of second hip fracture: an 11-year population-based cohort study in Taiwan.

作者信息

Chen Y J, Kung P T, Chou W Y, Tsai W C

机构信息

Department of Health Services Administration, China Medical University, Taiwan, No.91, Hsueh-Shih Road, Taichung, Taiwan, 40402, Republic of China.

Department of Orthopedic Surgery, China Medical University Hospital, Taiwan, No. 2, Yuh-Der Road, Taichung, Taiwan, 40402, Republic of China.

出版信息

Osteoporos Int. 2020 Aug;31(8):1555-1563. doi: 10.1007/s00198-020-05399-9. Epub 2020 Mar 27.

DOI:10.1007/s00198-020-05399-9

PMID:32221674

Abstract

UNLABELLED

Alendronate is effective in preventing second hip fracture in osteoporotic patients. However, no consensus exists on the duration that is effective in preventing a second hip fracture. Our study demonstrated that risk can be reduced when the prescription is ≥ 6 months for the year following the index hip fracture.

INTRODUCTION

Alendronate is effective in preventing second hip fracture in osteoporotic patients. However, no consensus exists on the accurate medication possession ratio (MPR) that is effective in preventing a second hip fracture. Our objective was to compare the risk of second hip fracture in patients treated with different MPR of alendronate.

METHODS

In this population-based cohort study, data from National Health Insurance Research Database of Taiwan were analyzed. Patients 50 years and older who had an index hip fracture and were not receiving any osteoporotic medications before their fracture during 2000-2010 were included. The cohort consisted of 88,320 patients who were new alendronate users (n = 9278) and non-users (n = 79,042). Those without alendronate were matched 4:1 as the control group. Patients were subdivided into those with no medication, MPR < 25%, MPR 25-50%, MPR 50-75%, and MPR 75-100%. Cox proportional hazard models were used to calculate the adjusted hazard ratios for different MPRs of alendronate.

RESULTS

After matching, 38,675 patients were included in this study; 20,363 (52.7%) were women, and 30,940 (80%) patients were without medication of alendronate. During follow-up on December 31, 2012, 2392 patients had a second hip fracture, for an incidence of 1449/100,000 person-years. Patients with alendronate MPR 50-75% had a lower risk of a second hip fracture compared to non-users (hazard ratio 0.66). When the MPR increased to 75-100%, the hazard ratio decreased to 0.61.

CONCLUSIONS

In this population-based cohort study, risk of a second hip fracture can be reduced when the alendronate MPR is ≥ 50% for the year following the index hip fracture. As the MPR increases, the risk of a second hip fracture decreases.

摘要

未标注

阿仑膦酸钠对预防骨质疏松症患者的二次髋部骨折有效。然而，对于预防二次髋部骨折有效的持续时间尚无共识。我们的研究表明，在首次髋部骨折后的一年内，如果处方时间≥6个月，风险可以降低。

引言

阿仑膦酸钠对预防骨质疏松症患者的二次髋部骨折有效。然而，对于预防二次髋部骨折有效的准确药物持有率（MPR）尚无共识。我们的目的是比较接受不同阿仑膦酸钠MPR治疗的患者发生二次髋部骨折的风险。

方法

在这项基于人群的队列研究中，分析了台湾国民健康保险研究数据库的数据。纳入2000年至2010年期间发生首次髋部骨折且在骨折前未接受任何骨质疏松症药物治疗的50岁及以上患者。该队列包括88320名新使用阿仑膦酸钠的患者（n = 9278）和未使用者（n = 79042）。未使用阿仑膦酸钠的患者按4:1匹配作为对照组。患者被分为未用药组、MPR<25%组、MPR 25 - 50%组、MPR 50 - 75%组和MPR 75 - 100%组。使用Cox比例风险模型计算不同阿仑膦酸钠MPR的调整后风险比。

结果

匹配后，本研究纳入38675名患者；20363名（52.7%）为女性，30940名（80%）患者未使用阿仑膦酸钠。在2012年12月31日的随访期间，2392名患者发生了二次髋部骨折，发病率为1449/100000人年。与未使用者相比，阿仑膦酸钠MPR为50 - 75%的患者发生二次髋部骨折的风险较低（风险比0.66）。当MPR增加到75 - 100%时，风险比降至0.61。