Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, Korea.
Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Korea.
J Korean Med Sci. 2021 Jul 12;36(27):e186. doi: 10.3346/jkms.2021.36.e186.
Selective estrogen receptor modulators (SERMs) were associated with an increased risk of venous thromboembolism (VTE) due to the estrogen effect. In this study, we investigated the effect of SERMs on VTE compared to bisphosphonates (BPs) using the Korean National Health Insurance claims database.
This was a retrospective cohort study. Women over 50 years old who were first prescribed BPs or SERMs for osteoporosis treatment in 2012 were included. The difference in VTE incidence between the SERMs and BP groups was compared. Both groups were followed up for VTE or PE occurrence, death, or until December 2016. The study population was analyzed by 3:1 matching according to age using a multivariate Cox model.
The hazard ratio (HR) for VTE was 0.72 (95% confidence interval [CI], 0.40-1.28) in the SERMs group compared to BP group. Older age (60-69 vs. 50-59 years: HR, 3.77; 95% CI, 2.07-6.86 and 70-79 vs. 50-59 years: HR, 5.88; 95% CI, 3.14-11.02), major osteoporotic fracture (HR, 1.77; 95% CI, 1.16- 2.70), atrial fibrillation (HR, 3.31; 95% CI, 1.35-8.11), and estrogen replacement (HR, 3.40; 95% CI, 2.01-5.73) all increased VTE risk. In subgroup analysis of the SERMs group, past hospitalization (HR, 2.24; 95% CI, 1.02-4.92), estrogen replacement (HR, 5.75; 95% CI, 2.29-14.39), and glucocorticoid replacement (HR, 2.71; 95% CI, 1.05-7.0) increased VTE risk.
SERMs did not increase the risk of VTE compared to BPs in Koreans with osteoporosis. However, old age and estrogen replacement both increased VTE risk.
由于雌激素的作用，选择性雌激素受体调节剂（SERMs）与静脉血栓栓塞（VTE）风险增加相关。在这项研究中，我们使用韩国国家健康保险索赔数据库研究了 SERMs 与双膦酸盐（BPs）相比对 VTE 的影响。
这是一项回顾性队列研究。纳入 2012 年首次因骨质疏松症接受 BP 或 SERMs 治疗的年龄大于 50 岁的女性。比较 SERMs 组和 BP 组的 VTE 发生率差异。两组均随访 VTE 或 PE 发生、死亡或直至 2016 年 12 月。使用多变量 Cox 模型根据年龄进行 3:1 匹配分析研究人群。
与 BP 组相比，SERMs 组 VTE 的风险比（HR）为 0.72（95%置信区间[CI]，0.40-1.28）。年龄较大（60-69 岁比 50-59 岁：HR，3.77；95%CI，2.07-6.86 和 70-79 岁比 50-59 岁：HR，5.88；95%CI，3.14-11.02）、主要骨质疏松性骨折（HR，1.77；95%CI，1.16-2.70）、心房颤动（HR，3.31；95%CI，1.35-8.11）和雌激素替代（HR，3.40；95%CI，2.01-5.73）均增加了 VTE 风险。在 SERMs 组的亚组分析中，既往住院（HR，2.24；95%CI，1.02-4.92）、雌激素替代（HR，5.75；95%CI，2.29-14.39）和糖皮质激素替代（HR，2.71；95%CI，1.05-7.0）增加了 VTE 风险。
与韩国骨质疏松症患者的 BP 相比，SERMs 并未增加 VTE 的风险。然而，年龄较大和雌激素替代均增加了 VTE 的风险。
