Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Bone. 2021 Sep;150:116003. doi: 10.1016/j.bone.2021.116003. Epub 2021 May 10.
Adults with epilepsy have an increased risk of fragility fractures, which contributes to an accelerated rate of premature morbidity and mortality. In the general population, osteoporosis treatment has shown improvements in health and survival, possibly through improving skeletal robustness; however, the effect of osteoporosis medication on survival among adults with epilepsy has not been investigated. The purpose of this propensity score-matched, observational cohort study was to determine if osteoporosis medication was associated with mortality risk among adults with epilepsy. An exploratory analysis then examined the association between the type of osteoporosis medication with mortality.
Data from 01/01/2012-09/30/2017 was extracted from Optum Clinformatics® Data Mart. Adults ≥50 years of age with epilepsy that were treatment naïve for and initiated osteoporosis medication (EP new users) were the primary group of interest, and were compared to adults with epilepsy that were not prescribed osteoporosis medication (EP no users) and adults without epilepsy that were treatment naïve for and initiated osteoporosis medication (w/o EP new users). Comparison groups were matched 1:4 to EP new users (n = 733; comparison groups, n = 2932) for demographics, glucocorticoid and antiseizure medication, prior 12-month fracture, and the Elixhauser comorbidity index. Crude incidence rate (IR) and IR ratio (IRR and 95% confidence intervals [CI]) was estimated for mortality for up to 3 years of follow-up. For new users, the association between type of osteoporosis medication (bisphosphonates vs. others) and mortality was explored using Cox proportional hazards regression after adjusting for all covariates.
For new users, the majority of the prescribed osteoporosis medications were bisphosphonates (~83%). The incidence of mortality for EP new users was lower compared to EP no users (IRR = 0.69; 95%CI = 0.52-0.93), but elevated compared to w/o EP new users (IRR = 1.42; 95%CI = 1.04-1.94). Comparing bisphosphonates to other medications for new users (P for EP group interaction = 0.089), EP new users showed a lower fully adjusted hazard ratio for mortality (HR = 0.56; 95%CI = 0.30-1.04), but was marginally insignificant (P = 0.066), while w/o EP new users showed no evidence of an association (HR = 1.09; 95%CI = 0.72-1.65).
Osteoporosis medication initiation was associated with a lower 3-year risk of mortality among adults with epilepsy. The exploratory analysis revealed potential evidence of a unique protective effect of bisphosphonates as compared to other osteoporosis medications on 3-year mortality for adults with epilepsy.
癫痫患者发生脆性骨折的风险增加，这导致其提前出现发病率和死亡率升高。在普通人群中，骨质疏松症治疗已显示出改善健康和生存状况的效果，这可能是通过改善骨骼健壮度实现的；然而，尚未研究骨质疏松症药物对癫痫患者的生存状况的影响。本倾向评分匹配、观察性队列研究的目的是确定骨质疏松症药物是否与癫痫成人的死亡风险相关。然后进行了一项探索性分析，以检查骨质疏松症药物类型与死亡率之间的关系。
从 2012 年 1 月 1 日至 2017 年 9 月 30 日，从 Optum Clinformatics Data Mart 中提取数据。50 岁及以上、新开始接受骨质疏松症药物治疗的癫痫患者（EP 新使用者）是主要研究对象，并与未接受骨质疏松症药物治疗的癫痫患者（EP 未使用者）和未患癫痫且新开始接受骨质疏松症药物治疗的患者（无 EP 新使用者）进行比较。比较组按照 1:4 的比例与 EP 新使用者（n=733；比较组，n=2932）进行匹配，以比较年龄、糖皮质激素和抗癫痫药物、前 12 个月的骨折情况以及 Elixhauser 合并症指数。对 3 年的随访期内的死亡进行了粗发病率（IR）和发病率比（IRR 和 95%置信区间 [CI]）的估计。对于新使用者，在调整所有协变量后，使用 Cox 比例风险回归分析来探讨骨质疏松症药物类型（双膦酸盐与其他药物）与死亡率之间的关系。
对于新使用者，处方的大多数骨质疏松症药物为双膦酸盐（~83%）。与 EP 未使用者相比，EP 新使用者的死亡率较低（IRR=0.69；95%CI=0.52-0.93），但与无 EP 新使用者相比，死亡率较高（IRR=1.42；95%CI=1.04-1.94）。对于新使用者，与其他药物相比，双膦酸盐（EP 组交互 P 值=0.089），EP 新使用者的全调整后死亡率风险比（HR）较低（HR=0.56；95%CI=0.30-1.04），但无统计学意义（P=0.066），而无 EP 新使用者则无关联证据（HR=1.09；95%CI=0.72-1.65）。
骨质疏松症药物的起始治疗与癫痫成人的 3 年死亡风险降低相关。探索性分析显示，与其他骨质疏松症药物相比，双膦酸盐可能对癫痫成人的 3 年死亡率具有独特的保护作用。
