他汀类药物使用与老年人骨质疏松性骨折风险的年龄和剂量依赖性效应。
Age- and dose-dependent effect of statin use on the risk of osteoporotic fracture in older adults.
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea.
出版信息
Osteoporos Int. 2023 Nov;34(11):1927-1936. doi: 10.1007/s00198-023-06879-4. Epub 2023 Aug 8.
UNLABELLED
Previous studies have revealed the protective effects of statins on bone but the association of statins use with osteoporosis-related measurement has shown controversial results. In this study, we found an age, dose andduration-dependent osteoprotective effect of statins in general older population.
PURPOSE
Previous studies have revealed the protective effects of statins on bone but the association of statins use with osteoporotic fractures has shown controversial results.
METHODS
In this study with Korean National Health Insurance Service-Senior cohort database, a total of 365,656 elderly without previous history of osteoporosis and who were started on statin since January 1 2004 were included and observed until December 31 2012. Hazard rations (HR) for major osteoporotic fractures were calculated using the weighted Cox proportional hazards model with inverse-probability of treatment weighting method.
RESULTS
During 6.27 years of follow-up period, 54,959 osteoporotic fractures occurred and the majority of fractures (69.5%) were vertebral fractures. Compared with non-users, statin use was associated with a decreased risk of all outcomes with adjusted HR (95% CI) of 0.77 (0.72-0.83; P < 0.001) for major osteoporotic fractures, 0.49 (0.38-0.62; P < 0.001) for hip fractures, and 0.70 (0.64-0.77; P < 0.001) for vertebral fractures. When outcomes were examined separately by sex, the results were broadly comparable in terms of patterns of risk reduction by statin use. The patients with statin initiated at age ≥ 80 years had the highest risk reduction for most outcomes relative to non-users. Higher cumulative dose of statin was negatively associated with the osteoporotic fracture risk; 0.97 (0.91-1.02) for 30-364 cumulative daily defined dose (cDDD), 0.45 (0.40-0.51) for 365-1,094 cDDD, and 0.22 (0.15-0.33) for ≥ 1,095 cDDD.
CONCLUSIONS
Our results showed that statin use was associated with significant reduction in the risk of osteoporotic fractures in general older population.
未注明
先前的研究表明他汀类药物对骨骼有保护作用，但他汀类药物的使用与骨质疏松症相关测量的关联结果存在争议。在这项研究中，我们发现他汀类药物在一般老年人群中有年龄、剂量和持续时间依赖性的护骨作用。
目的
先前的研究表明他汀类药物对骨骼有保护作用，但他汀类药物的使用与骨质疏松性骨折的关系结果存在争议。
方法
本研究使用韩国国家健康保险服务-老年人队列数据库，共纳入 365656 名无骨质疏松症既往史且自 2004 年 1 月 1 日开始服用他汀类药物的老年人，观察至 2012 年 12 月 31 日。采用加权 Cox 比例风险模型和逆概率治疗加权法计算主要骨质疏松性骨折的危险比 (HR)。
结果
在 6.27 年的随访期间，发生了 54959 例骨质疏松性骨折，其中大多数骨折（69.5%）为椎体骨折。与未使用者相比，他汀类药物使用者的所有结局的风险均降低，调整后的 HR（95%CI）为 0.77（0.72-0.83；P<0.001），主要骨质疏松性骨折，0.49（0.38-0.62；P<0.001），髋部骨折，0.70（0.64-0.77；P<0.001），椎体骨折。当按性别分别检查结局时，在他汀类药物使用者风险降低模式方面，结果大致相似。与未使用者相比，起始年龄≥80 岁的患者对大多数结局的风险降低最大。他汀类药物的累积剂量越高，与骨质疏松性骨折风险呈负相关；30-364 个每日规定剂量（cDDD）为 0.97（0.91-1.02），365-1094 cDDD 为 0.45（0.40-0.51），≥1095 cDDD 为 0.22（0.15-0.33）。
结论
我们的研究结果表明，他汀类药物的使用与一般老年人群骨质疏松性骨折风险的显著降低有关。
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