Bauer D C, Orwoll E S, Fox K M, Vogt T M, Lane N E, Hochberg M C, Stone K, Nevitt M C
Division of General Internal Medicine, University of California, San Francisco, USA.
J Bone Miner Res. 1996 Jan;11(1):29-35. doi: 10.1002/jbmr.5650110106.
Prostaglandin inhibition by aspirin or nonsteroidal anti-inflammatory drug (NSAIDs) may inhibit bone loss and preserve bone mineral density (BMD) in vitro and in animal models. The effect of these agents on BMD and fracture risk in postmenopausal women in unknown. We assessed the risk factors for osteoporosis and the use of aspirin and NSAIDs in 7786 white women over age 65. Axial BMD was measured at the same time, and fractures were prospectively documented over the subsequent 4 years of follow-up. In age-adjusted analyses, daily use of aspirin or NSAIDs was associated with a 2.3-5.8% increase in BMD of the hip and spine. The relationship persisted even after adjustment for weight, a variety of medications, self-reported arthritis, and for radiographic findings of osteoarthritis, but the multiply adjusted increase in BMD was only 1.0-3.1%. Fracture risk was similar among daily users of aspirin and NSAIDs and nonusers. After adjustment for potential confounders, among daily aspirin users the relative risk of hip fracture was 1.1 (95% confidence interval [CI]: 0.7, 1.6), and among daily NSAID users the risk was 0.9 (CI: 0.6, 1.4). Considering all nonspine fractures together, the risk among aspirin users was 1.0 (CI: 0.8. 1.2), and among NSAID users the risk was also 1.0 (CI; 0.8, 1.2). Regular use of aspirin or NSAIDs may have a modest beneficial effect on BMD in postmenopausal women. This effect persists after adjustment for obesity and the presence of osteoarthritis. However, among women who take aspirin or NSAIDs regularly, there is no clinically significant protective effect on the subsequent risk of fractures.
阿司匹林或非甾体抗炎药（NSAIDs）对前列腺素的抑制作用在体外和动物模型中可能会抑制骨质流失并维持骨矿物质密度（BMD）。这些药物对绝经后女性的骨密度和骨折风险的影响尚不清楚。我们评估了7786名65岁以上白人女性的骨质疏松症风险因素以及阿司匹林和NSAIDs的使用情况。同时测量了她们的轴向骨密度，并在随后4年的随访中对骨折情况进行了前瞻性记录。在年龄调整分析中，每日使用阿司匹林或NSAIDs与髋部和脊柱骨密度增加2.3%至5.8%相关。即使在对体重、多种药物、自我报告的关节炎以及骨关节炎的影像学表现进行调整后，这种关系仍然存在，但经多重调整后的骨密度增加仅为1.0%至3.1%。阿司匹林和NSAIDs的每日使用者与非使用者的骨折风险相似。在对潜在混杂因素进行调整后，每日服用阿司匹林的使用者中髋部骨折的相对风险为1.1（95%置信区间[CI]：0.7，1.6），每日服用NSAIDs的使用者中风险为0.9（CI：0.6，1.4）。将所有非脊柱骨折合并考虑，阿司匹林使用者的风险为1.0（CI：0.8，1.2），NSAIDs使用者的风险也为1.0（CI：0.8，1.2）。定期使用阿司匹林或NSAIDs可能对绝经后女性的骨密度有适度的有益影响。在对肥胖和骨关节炎的存在进行调整后，这种影响仍然存在。然而，在经常服用阿司匹林或NSAIDs的女性中，对随后的骨折风险没有临床显著的保护作用。
