Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Postgrad Med J. 2023 May 22;99(1170):340-349. doi: 10.1136/postgradmedj-2021-140341.
The risk of bone fracture is high in patients with chronic kidney disease (CKD), and aggressive treatment to reduce fragility fracture risk is the major strategy. However, the outcomes of osteoporosis medications in patients with CKD remain unclear.
Patients with stage 3-5 CKD during 2011-2019 were enrolled. Patients were divided into two groups based on receiving osteoporosis medications (bisphosphonates, raloxifene, teriparatide or denosumab) or not. Two groups were matched at a 1:1 ratio by using propensity scores. The outcomes of interest were bone fractures, cardiovascular (CV) events and all-cause mortality. Cox proportional hazard regression models were applied to identify the risk factors. Additional stratified analyses by cumulative dose, treatment length and menopause condition were performed.
67 650 patients were included. After propensity score matching, 1654 patients were included in the study and control group, respectively. The mean age was 70.2±12.4 years, and 32.0% of patients were men. After a mean follow-up of 3.9 years, the incidence rates of bone fracture, CV events and all-cause mortality were 2.0, 1.7 and 6.5 per 1000 person-months, respectively. Multivariate analysis results showed that osteoporosis medications reduced the risk of CV events (HR, 0.35; 95% CI, 0.18 to 0.71; p = 0.004), but did not alleviate the risks of bone fracture (HR, 1.48; 95% CI, 0.73 to 2.98; p = 0.28) and all-cause mortality (HR, 0.93; 95% CI, 0.67 to 1.28; p = 0.65). Stratified analysis showed that bisphosphonates users have most benefits in the reduction of CV events (HR, 0.26; 95% CI, 0.11 to 0.64; p = 0.003). In conclusion, osteoporosis medications did not reduce the risk of bone fractures, or mortality, but improved CV outcomes in patients with CKD.
慢性肾脏病（CKD）患者骨折风险较高，积极治疗以降低脆性骨折风险是主要策略。然而，CKD 患者骨质疏松症药物的治疗效果仍不明确。
纳入 2011 年至 2019 年期间患有 3-5 期 CKD 的患者。根据是否使用骨质疏松症药物（双磷酸盐、雷洛昔芬、特立帕肽或地舒单抗）将患者分为两组。采用倾向评分匹配法以 1:1 的比例将两组进行匹配。主要结局为骨折、心血管（CV）事件和全因死亡率。采用 Cox 比例风险回归模型识别风险因素。并进行了累积剂量、治疗时间和绝经状况的分层分析。
共纳入 67650 例患者。经倾向评分匹配后，分别纳入 1654 例患者进入研究组和对照组。患者平均年龄为 70.2±12.4 岁，32.0%为男性。平均随访 3.9 年后，骨折、CV 事件和全因死亡率的发生率分别为 2.0、1.7 和 6.5/1000 人年。多因素分析结果显示，骨质疏松症药物降低了 CV 事件的风险（HR 0.35，95%CI 0.18-0.71，p=0.004），但未降低骨折（HR 1.48，95%CI 0.73-2.98，p=0.28）和全因死亡率（HR 0.93，95%CI 0.67-1.28，p=0.65）的风险。分层分析显示，双磷酸盐使用者在降低 CV 事件方面获益最大（HR 0.26，95%CI 0.11-0.64，p=0.003）。综上，骨质疏松症药物不能降低 CKD 患者的骨折风险或死亡率，但可改善 CV 结局。
