在骨折联络服务门诊就诊的患者中，经过三年随访，使用质子泵抑制剂（PPI）与通过高分辨率外周定量计算机断层扫描（HR-pQCT）评估的骨微结构和强度无关。

PPI use is not associated with bone microarchitecture and strength assessed with HR-pQCT after three-years follow-up in patients visiting the Fracture Liaison Service.

作者信息

Schene M R, Bevers M S A M, van der Vijgh W J F, Driessen J H M, Vranken L, van der Velde R Y, Willems H C, Wyers C E, van den Bergh J P

机构信息

Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Amsterdam UMC location University of Amsterdam, Internal Medicine and Geriatrics, Meibergdreef 9, Amsterdam, Netherlands.

Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.

出版信息

Bone. 2024 May;182:117066. doi: 10.1016/j.bone.2024.117066. Epub 2024 Mar 2.

DOI:10.1016/j.bone.2024.117066

PMID:38438097

Abstract

BACKGROUND

The use of proton pump inhibitors (PPIs) has been associated with an increased fracture risk in observational studies. However, the reported association between PPI use and bone mineral density (BMD), bone microarchitecture, and bone strength is inconsistent. This study aims to assess the association between PPI use and bone microarchitecture and strength using high-resolution peripheral quantitative CT (HR-pQCT) in a three-year follow-up study in patients with a recent fracture visiting the Fracture Liaison Service (FLS).

METHODS

This three-year prospective cohort study included FLS patients aged ≥ 50 years with a recent fracture (median age 62 [IQR 56-69] years, 68.7 % females) and without anti-osteoporosis treatment indication. HR-pQCT scans (distal radius and tibia) were obtained at baseline (T0) and three-year follow-up (T3). Volumetric bone mineral density and bone area, microarchitecture, and strength (micro-finite element analysis) were determined. The association between three-year continuous PPI use and the percentage change in HR-pQCT parameters between T0 and T3 was assessed using sex-stratified multivariate linear regression analyses. Covariates included age, BMI, vitamin-D deficiency (< 50 nmol/l), glucocorticoid use, and cardiovascular co-morbidity (males and females) fracture type (major/hip vs. all others, only males) and probable sarcopenia (only females).

RESULTS

In total, 282 participants had available medication data throughout follow-up, of whom 20.6 % were continuous PPI users. In both males and females with complete HR-pQCT follow-up data (males: N = 69 radius, N = 84 tibia; females: N = 147 radius, N = 168 tibia), PPI use was not associated with the percentage change of any of the bone microarchitecture or strength parameters between T0 and T3 at the radius and tibia as compared to non-use.

CONCLUSION

Compared to non-use, PPI use was not associated with the change of bone microarchitecture and strength in FLS patients at three years of follow-up. These results do not support that an altered bone microarchitecture or strength may contribute to the increased fracture risk associated with PPI use, as reported in observational studies.

摘要

背景

在观察性研究中，质子泵抑制剂（PPI）的使用与骨折风险增加相关。然而，关于PPI使用与骨矿物质密度（BMD）、骨微结构和骨强度之间的关联报道并不一致。本研究旨在通过高分辨率外周定量CT（HR-pQCT），在一项针对近期骨折并就诊于骨折联络服务（FLS）的患者的三年随访研究中，评估PPI使用与骨微结构和强度之间的关联。

方法

这项为期三年的前瞻性队列研究纳入了年龄≥50岁、近期有骨折（中位年龄62岁[四分位间距56 - 69岁]，68.7%为女性）且无抗骨质疏松治疗指征的FLS患者。在基线（T0）和三年随访（T3）时进行HR-pQCT扫描（桡骨远端和胫骨）。测定骨体积密度、骨面积、微结构和强度（微有限元分析）。使用性别分层的多变量线性回归分析评估三年持续使用PPI与T0至T3期间HR-pQCT参数百分比变化之间的关联。协变量包括年龄、体重指数、维生素D缺乏（<50 nmol/l）、糖皮质激素使用、心血管合并症（男性和女性）、骨折类型（主要/髋部骨折与其他所有骨折，仅男性）以及可能的肌肉减少症（仅女性）。

结果

共有282名参与者在整个随访期间有可用的用药数据，其中20.6%为持续PPI使用者。在具有完整HR-pQCT随访数据的男性和女性中（男性：桡骨N = 69，胫骨N = 84；女性：桡骨N = 147，胫骨N = 168），与未使用PPI相比，使用PPI与T0至T3期间桡骨和胫骨的任何骨微结构或强度参数的百分比变化均无关联。