Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Aging (Albany NY). 2022 Mar 1;14(5):2239-2251. doi: 10.18632/aging.203927.
Osteoporotic fracture is a common public-health problem in ageing societies. Although post-fracture usage of osteoporosis medications may reduce mortality, recent results have been inconsistent. We aimed to examine associations between osteoporosis medication and mortality in older adults, particularly oldest-old adults (>=85 years old).
Participants aged 65 years old and older newly diagnosed with both osteoporosis and hip or vertebral fractures within 2009-2017 were recruited from the records of 23,455,164 people in Taiwan National Health Insurance Research Database (NHIRD). Osteoporosis medication exposure was calculated after the first-time ambulatory visit with newly diagnosed osteoporosis. Mortality and its specific causes were ascertained from Cause of Death Data. Patients were followed until death or censored at the end of 2018.
A total of 87,935 participants aged 65 years old and over (73.4% female), with a mean 4.13 follow-up years, were included. Taking medication was associated with significantly lower risk of mortality (hip fracture HR 0.75, vertebral fracture HR 0.74), even in the oldest-old adults (hip fracture HR 0.76, vertebral fracture HR 0.72), where a longer duration of taking osteoporosis medication was associated with lower all-cause mortality. Specific causes of mortality were also significantly lower for participants taking osteoporosis medication (cancer HR 0.84 in hip fracture, 0.75 in vertebral fracture; cardiovascular disease HR 0.85 in hip fracture, 0.91 in vertebral fracture).
Osteoporosis medication after hip or vertebral fracture may reduce mortality risk in older adults, notably in oldest-old adults. Encouraging the use of post-fracture osteoporosis medication in healthcare policies is warranted.
骨质疏松性骨折是老龄化社会中常见的公共卫生问题。虽然骨折后使用骨质疏松症药物可能会降低死亡率，但最近的结果并不一致。我们旨在研究骨质疏松症药物与老年人，特别是最年长的老年人（>=85 岁）骨折后死亡率之间的关系。
我们从台湾全民健康保险研究数据库（NHIRD）的 23455164 人的记录中招募了 2009-2017 年期间新诊断出骨质疏松症和髋部或椎体骨折的 65 岁及以上的参与者。在首次诊断为骨质疏松症后的门诊就诊时计算了骨质疏松症药物的暴露情况。从死因数据确定了死亡率及其具体原因。患者随访至死亡或 2018 年底截尾。
共纳入 87935 名年龄在 65 岁及以上（73.4%为女性）的患者，平均随访时间为 4.13 年。服用药物与死亡率显著降低相关（髋部骨折 HR 0.75，椎体骨折 HR 0.74），即使在最年长的老年人中也是如此（髋部骨折 HR 0.76，椎体骨折 HR 0.72），服用骨质疏松症药物的时间越长，全因死亡率越低。服用骨质疏松症药物的患者，其特定死因的死亡率也显著降低（髋部骨折的癌症 HR 0.84，椎体骨折的癌症 HR 0.75；髋部骨折的心血管疾病 HR 0.85，椎体骨折的心血管疾病 HR 0.91）。
髋部或椎体骨折后使用骨质疏松症药物可能会降低老年人，特别是最年长的老年人的死亡率风险。在医疗保健政策中鼓励使用骨折后骨质疏松症药物是合理的。
