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脆性骨折手术后双膦酸盐（阿仑膦酸钠）起始治疗的时机：一项基于人群的队列研究。

Timing of Bisphosphonate (Alendronate) Initiation after Surgery for Fragility Fracture: A Population-Based Cohort Study.

作者信息

Wu Meng-Huang, Lin Yu-Sheng, Wu Christopher, Lee Ching-Yu, Chen Yi-Chia, Huang Tsung-Jen, Cheng Jur-Shan

机构信息

Department of Orthopedics, Taipei Medical University Hospital, Taipei 110301, Taiwan.

Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan.

出版信息

J Clin Med. 2021 Jun 8;10(12):2541. doi: 10.3390/jcm10122541.

DOI:10.3390/jcm10122541
PMID:34201202
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8229144/
Abstract

Bisphosphonates are used as first-line treatment for the prevention of fragility fracture (FF); they act by inhibiting osteoclast-mediated bone resorption. The timing of their administration after FF surgery is controversial; thus, we compared the incidence of second FF, surgery for second FF, and adverse events associated with early initiation of bisphosphonates (EIBP, within 3 months of FF surgery) and late initiation of bisphosphonates (LIBP, 3 months after FF surgery) in bisphosphonate-naïve patients. This retrospective population-based cohort study used data from Taiwan's Health and Welfare Data Science Center (2004-2012). A total of 298,377 patients received surgeries for FF between 2006 and 2010; of them, 1209 (937 EIBP and 272 LIBP) received first-time bisphosphonates (oral alendronate, 70 mg, once a week). The incidence of second FF (subdistribution hazard ratio (SHR) = 0.509; 95% confidence interval (CI): 0.352-0.735), second FF surgery (SHR = 0.452; 95% CI: 0.268-0.763), and adverse events (SHR = 0.728; 95% CI: 0.594-0.893) was significantly lower in the EIBP group than in the LIBP group. Our findings indicate that bisphosphonates should be initiated within 3 months after surgery for FF.

摘要

双膦酸盐类药物用作预防脆性骨折（FF）的一线治疗药物；其作用机制是抑制破骨细胞介导的骨吸收。FF手术后使用双膦酸盐类药物的时机存在争议；因此，我们比较了在未使用过双膦酸盐类药物的患者中，早期开始使用双膦酸盐类药物（EIBP，FF手术后3个月内）和晚期开始使用双膦酸盐类药物（LIBP，FF手术后3个月）时二次FF的发生率、二次FF手术的发生率以及不良事件的发生率。这项基于人群的回顾性队列研究使用了台湾健康与福利数据科学中心（2004 - 2012年）的数据。2006年至2010年期间，共有298,377例患者接受了FF手术；其中，1209例（937例EIBP和272例LIBP）首次使用双膦酸盐类药物（口服阿仑膦酸钠，70毫克，每周一次）。EIBP组二次FF的发生率（亚分布风险比（SHR）= 0.509；95%置信区间（CI）：0.352 - 0.735）、二次FF手术的发生率（SHR = 0.452；95%CI：0.268 - 0.763）和不良事件的发生率（SHR = 0.728；95%CI：0.594 - 0.893）均显著低于LIBP组。我们的研究结果表明，FF手术后应在3个月内开始使用双膦酸盐类药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/0edd2eb1b5a2/jcm-10-02541-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/d011dbcda1cd/jcm-10-02541-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/bfe9444d4782/jcm-10-02541-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/7157257b73e7/jcm-10-02541-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/0edd2eb1b5a2/jcm-10-02541-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/d011dbcda1cd/jcm-10-02541-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/bfe9444d4782/jcm-10-02541-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/7157257b73e7/jcm-10-02541-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5f2/8229144/0edd2eb1b5a2/jcm-10-02541-g004.jpg

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Timing of anti-osteoporosis medications initiation after a hip fracture affects the risk of subsequent fracture: A nationwide cohort study.髋部骨折后开始使用抗骨质疏松药物的时机影响随后骨折的风险：一项全国性队列研究。
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