Department of Orthopedic Surgery, Asahi General Hospital, Toyama, Japan.
Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan.
Geriatr Gerontol Int. 2024 Apr;24(4):390-397. doi: 10.1111/ggi.14853. Epub 2024 Mar 12.
This retrospective cohort study assessed the association between the incidence of secondary vertebral fracture managed with a brace (SVF) and pharmacotherapy.
The association between the incidence of SVF and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan.
The data of female patients (n = 637 303) were analyzed. The 2-year incidence of SVF was 73.5 per 10 000 patients (n = 4687). Approximately 0.73% of patients without medications and 0.74% with medications had SVF. Patients taking bisphosphonates (0.87), denosumab (0.77), and selective estrogen receptor modulators (0.88) had significantly lower standardized incidence ratios (SIRs) than patients not taking medications after the occurrence of primary fracture; meanwhile, patients taking parathyroid hormone medications had considerably higher SIRs than those not taking medications. The non-SVF group (59.1%) had a significantly higher mean MPR than the SVF group (55.5%). Patients taking denosumab in the non-SVF group (68.2%) had the highest mean MPR. The proportion of patients taking denosumab with an MPR of ≥80% in the non-SVF group was significantly higher than that in the SVF group.
Patients taking medications were at a lower risk of developing SVF than those not taking medications. Although this study did not compare the medications' SVF prevention effects, patients taking denosumab had a 0.77 SIR of SVF in Japan. The effect of pharmacotherapy on SVF prevention might be affected by the MPR of each medication. Geriatr Gerontol Int 2024; 24: 390-397.
本回顾性队列研究评估了支具治疗（SVF）和药物治疗继发性椎体骨折（SVF）发生率之间的关联。
利用从日本国民健康保险索赔和特定健康检查全国数据库获得的医疗保险数据，研究 SVF 发生率与药物治疗的存在、类型和药物持有率（MPR）之间的关系。
分析了女性患者（n=637303）的数据。SVF 的 2 年发生率为每 10000 名患者 73.5 例（n=4687）。无药物治疗的患者中有 0.73%，有药物治疗的患者中有 0.74%发生 SVF。与未发生原发性骨折后未服用药物的患者相比，服用双膦酸盐（0.87）、地舒单抗（0.77）和选择性雌激素受体调节剂（0.88）的患者的标准化发病比（SIR）显著降低；而服用甲状旁腺激素药物的患者的 SIR 明显高于未服用药物的患者。非 SVF 组（59.1%）的平均 MPR 明显高于 SVF 组（55.5%）。非 SVF 组中服用地舒单抗的患者（68.2%）的平均 MPR 最高。非 SVF 组中地舒单抗 MPR≥80%的患者比例明显高于 SVF 组。
与未服用药物的患者相比，服用药物的患者发生 SVF 的风险较低。尽管本研究未比较药物预防 SVF 的效果，但在日本，服用地舒单抗的患者 SVF 的 SIR 为 0.77。药物治疗对 SVF 预防的效果可能受每种药物 MPR 的影响。老年医学与老年健康学杂志 2024；24：390-397。
