Division of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.
Eur J Endocrinol. 2024 Aug 30;191(3):361-369. doi: 10.1093/ejendo/lvae111.
Osteoporosis-related fractures are associated with increased mortality risk among postmenopausal women, yet the impact of antiosteoporotic medications on mortality is not fully understood.
This study evaluates the effect of antiresorptive agents (ARs) on mortality risk in postmenopausal women with osteoporosis.
This is a nationwide cohort study using data from the National Screening Program for Transitional Ages (2008-2017).
Data were derived from a national cohort of postmenopausal women in South Korea.
This study included 117 871 postmenopausal women diagnosed with osteoporosis. Of them, 15 895 patients who used ARs, such as bisphosphonates or selective estrogen receptor modulators, for at least 1 year were matched 1:1 with nonusers using propensity scores.
Exposure to ARs for at least 1 year was compared with no AR use.
Mortality outcomes were assessed using multivariable Cox proportional hazard regression models, focusing on all-cause mortality and cause-specific mortality, particularly cardiovascular disease (CVD) and injury-/fracture-related deaths.
In AR users, there were 102 deaths (mortality rate 1.41 per 1000 person-years), compared with 221 deaths in non-users (mortality rate 3.14 per 1000 person-years), yielding a hazard ratio (HR) of 0.43 (95% CI, 0.34-0.54). Antiresorptive agent users showed a 52% reduction in CVD mortality risk (HR, 0.48; 95% CI, 0.34-0.69) and a 54% reduction in injury-/fracture-related mortality risk (HR, 0.46; 95% CI, 0.27-0.76). The analysis indicated a consistent decrease in all-cause and CVD mortality risks with longer durations of AR use.
The use of ARs in postmenopausal women with osteoporosis is associated with significantly lower risks of all-cause mortality, especially from cardiovascular events and fractures. The mortality reduction benefits appear to be enhanced with prolonged AR therapy, highlighting the potential importance of sustained treatment in this population.
骨质疏松症相关骨折与绝经后妇女的死亡率风险增加相关，然而，抗骨质疏松药物对死亡率的影响尚不完全清楚。
本研究评估了抗吸收剂（ARs）对骨质疏松症绝经后妇女的死亡率风险的影响。
这是一项全国性的队列研究，使用国家过渡年龄筛查计划（2008-2017 年）的数据。
数据来自韩国全国绝经后妇女队列。
本研究包括 117871 名诊断为骨质疏松症的绝经后妇女。其中，15895 名患者至少使用了 1 年的 AR，如双磷酸盐或选择性雌激素受体调节剂，通过倾向评分与 1:1 未使用者匹配。
至少使用 1 年的 AR 与未使用 AR 进行比较。
使用多变量 Cox 比例风险回归模型评估死亡率结果，重点关注全因死亡率和病因特异性死亡率，特别是心血管疾病（CVD）和损伤/骨折相关死亡。
在 AR 使用者中，有 102 人死亡（死亡率为每 1000 人年 1.41 人），而未使用者中有 221 人死亡（死亡率为每 1000 人年 3.14 人），风险比（HR）为 0.43（95%CI，0.34-0.54）。抗吸收剂使用者的 CVD 死亡率风险降低了 52%（HR，0.48；95%CI，0.34-0.69），损伤/骨折相关死亡率风险降低了 54%（HR，0.46；95%CI，0.27-0.76）。分析表明，随着 AR 使用时间的延长，全因和 CVD 死亡率的风险呈持续下降趋势。
在患有骨质疏松症的绝经后妇女中使用 ARs 与全因死亡率，特别是心血管事件和骨折的风险显著降低相关。随着 AR 治疗的延长，死亡率降低的益处似乎增强，这突出了在这一人群中持续治疗的潜在重要性。
