Morton D J, Barrett-Connor E L, Schneider D L
University of California, San Diego, La Jolla, California 92093-0607, USA.
J Bone Miner Res. 1998 Dec;13(12):1924-31. doi: 10.1359/jbmr.1998.13.12.1924.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to inhibit synthesis of prostaglandins and may help prevent bone loss, but no study has shown the differential association of type or dose of NSAID compound with bone mineral density (BMD). The purpose of this study was to determine the relation of NSAIDs by type and dose to BMD. Participants were 932 Caucasian, community-dwelling women aged 44-98 years from southern California. Data were collected from 1988 to 1991 through the use of standardized medical questionnaires. Medication use was validated by a nurse. BMD at the ultradistal and midshaft radii were measured using single-photon absorptiometry, and at the hip and lumbar spine using dual-energy X-ray absorptiometry. Women (mean age, 72 years) were classified into 818 nonusers and 114 regular daily users of NSAIDs, of which 84 used propionic acid NSAIDs and the remainder used acetic acid NSAIDs. Occasional NSAID users were excluded. Women who used propionic acid NSAIDs, but not acetic acid NSAIDs, had higher BMD at all five sites and significantly higher BMD at the midshaft radius and lumbar spine. These differences remained after controlling for known covariates of osteoporosis. When women with self-reported osteoarthritis were excluded from the model, significantly higher BMD in propionic acid NSAID users was also observed at the femoral neck and total hip. Those who concurrently used estrogen and propionic acid NSAIDs had the highest BMD at all sites, suggesting an additive effect. We conclude that regular daily use of propionic acid NSAIDs, with or without simultaneous use of estrogen, may be helpful in preventing bone loss in older women. However, further research is needed to confirm these results before any clinical practice guidelines can be recommended due to the increased risk of serious complications associated with NSAID use.
已知非甾体抗炎药（NSAIDs）可抑制前列腺素的合成，并可能有助于预防骨质流失，但尚无研究表明NSAID化合物的类型或剂量与骨矿物质密度（BMD）之间存在差异关联。本研究的目的是确定NSAIDs的类型和剂量与BMD的关系。研究对象为932名年龄在44 - 98岁之间、居住在南加州社区的白种女性。数据收集于1988年至1991年，通过使用标准化医疗问卷进行。用药情况由护士进行核实。使用单光子吸收法测量尺骨远侧和骨干中部的BMD，使用双能X线吸收法测量髋部和腰椎的BMD。女性（平均年龄72岁）被分为818名未使用NSAIDs者和114名每日规律使用NSAIDs者，其中84人使用丙酸类NSAIDs，其余使用乙酸类NSAIDs。偶尔使用NSAIDs者被排除。使用丙酸类NSAIDs但未使用乙酸类NSAIDs的女性在所有五个部位的BMD均较高，在骨干中部和腰椎的BMD显著更高。在控制了已知的骨质疏松症协变量后，这些差异仍然存在。当将自我报告患有骨关节炎的女性从模型中排除后，在股骨颈和全髋部位也观察到丙酸类NSAIDs使用者的BMD显著更高。同时使用雌激素和丙酸类NSAIDs的女性在所有部位的BMD最高，表明存在相加效应。我们得出结论，每日规律使用丙酸类NSAIDs，无论是否同时使用雌激素，可能有助于预防老年女性骨质流失。然而，由于使用NSAIDs会增加严重并发症的风险，在推荐任何临床实践指南之前，需要进一步研究来证实这些结果。
