Department of Endocrinology, Sahlgrenska University Hospital, 413 46, Gothenburg, Sweden.
Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden.
Osteoporos Int. 2024 Sep;35(9):1585-1593. doi: 10.1007/s00198-024-07132-2. Epub 2024 Jun 5.
In this large population-based matched cohort study, patients with primary aldosteronism were at increased risk of hip fracture, particularly subgroups traditionally considered at higher risk of osteoporosis such as women, patients older than 56 years at diagnosis, patients with established cardiovascular disease at diagnosis, and patients treated with MRA.
Previous studies suggest that primary aldosteronism (PA) is associated with dysregulated bone homeostasis. The aim of this study was to evaluate the incidence of hip fractures in patients with PA.
We studied a nationwide cohort of 2419 patients with PA (1997-2019) and 24 187 age and sex matched controls from the general population. Hip fractures were identified by ICD codes in the Swedish National Patient Register. We estimated hazard ratios (HRs) for incident hip fractures, adjusted for prior fractures, socioeconomic factors, diabetes, osteoporosis, hyperparathyroidism, and cardiovascular disease (CVD). Pairwise subgroup comparisons were performed by age (18-56 and > 56 years), sex, CVD at baseline, and treatment for PA.
During a mean follow up of 8 ± 5 years, 64 (2.6%) patients had a hip fracture after being diagnosed with PA, compared to 401 (1.7%) controls. After adjustments, PA was associated with a 55% increased risk of hip fracture compared to controls (HR 1.55 [1.18-2.03]). HRs were increased in women (HR 1.76 [95% CI 1.24-2.52]), patients aged > 56 years (HR 1.62 [95% CI 1.21-2.17]), and patients with CVD at diagnosis (HR 2.15 [95% CI 1.37-3.37]). PA patients treated with adrenalectomy did not have higher risk than controls (HR 0.84 [95% CI 0.35-2.0]), while patients treated with mineralocorticoid receptor antagonists (MRA) retained a greater risk (HR 1.84 [95% CI 1.20-2.83]).
PA is associated with increased hip fracture risk, especially in women, patients diagnosed after the age of 56 years and patients with established CVD at diagnosis. Also, patients treated with MRA seem to have an increased risk of hip fractures, while adrenalectomy may be protective.
在这项大型基于人群的匹配队列研究中，原发性醛固酮增多症患者髋部骨折风险增加，尤其是传统上认为骨质疏松风险较高的亚组，如女性、诊断时年龄大于 56 岁、诊断时已患有心血管疾病以及接受 MRA 治疗的患者。
先前的研究表明，原发性醛固酮增多症（PA）与骨稳态失调有关。本研究旨在评估 PA 患者髋部骨折的发生率。
我们研究了一个全国性的 2419 例 PA 患者队列（1997-2019 年）和来自普通人群的 24187 例年龄和性别匹配的对照者。通过瑞典国家患者登记处的 ICD 编码确定髋部骨折。我们通过骨折既往史、社会经济因素、糖尿病、骨质疏松症、甲状旁腺功能亢进症和心血管疾病（CVD）等因素，对新发髋部骨折的风险比（HR）进行了调整。通过年龄（18-56 岁和>56 岁）、性别、基线时的 CVD 和 PA 治疗，进行了两两亚组比较。
在平均 8±5 年的随访期间，64 例（2.6%）PA 患者在诊断后发生髋部骨折，而对照组中为 401 例（1.7%）。调整后，PA 患者髋部骨折风险比对照组增加 55%（HR 1.55[1.18-2.03]）。女性（HR 1.76[95%CI 1.24-2.52]）、年龄>56 岁（HR 1.62[95%CI 1.21-2.17]）和诊断时患有 CVD（HR 2.15[95%CI 1.37-3.37]）的患者 HR 更高。接受肾上腺切除术的 PA 患者与对照组相比，风险并未增加（HR 0.84[95%CI 0.35-2.0]），而接受盐皮质激素受体拮抗剂（MRA）治疗的患者风险更高（HR 1.84[95%CI 1.20-2.83]）。
PA 与髋部骨折风险增加相关，尤其是在女性、诊断时年龄大于 56 岁和诊断时已患有 CVD 的患者中。此外，接受 MRA 治疗的患者似乎髋部骨折风险增加，而肾上腺切除术可能具有保护作用。
