期刊
JOURNAL OF BONE AND MINERAL RESEARCH
卷 33, 期 3, 页码 419-429出版社
WILEY
DOI: 10.1002/jbmr.3318
关键词
BISPHOSPHONATES; GLUCOCORTICOID; FRACTURE RISK; EFFECTIVENESS; OSTEOPOROSIS
资金
- Canadian Network for Advanced Interdisciplinary Methods for Comparative Effectiveness Research (CAN-AIM) Training Scholarship
- Queen Elizabeth II/Pfizer Graduate Scholarship in Science and Technology
- Drug Safety and Effectiveness Cross-Disciplinary Training (DSECT) Scholarship
- Graduate Department of Pharmaceutical Sciences Recognition Awards
- Leslie Dan Faculty of Pharmacy Dean's Entrance Scholarship
The benefit of oral bisphosphonates in reducing fracture risk in glucocorticoid-induced osteoporosis is controversial. We aimed to estimate the effectiveness of oral bisphosphonates in reducing fracture risk in a cohort of new chronic oral glucocorticoid users. We created three matched cohorts using health care administrative data from Ontario, Canada. We included residents aged 66 years and older initiating chronic oral glucocorticoids (450mg prednisone equivalent and 2 glucocorticoid prescriptions within a 6-month window) between January 1998 and September 2014. Exposed patients were those who initiated an oral bisphosphonate (alendronate, etidronate, or risedronate) within the first 6 months of starting chronic oral glucocorticoid therapy. Exposed cohorts (3945 alendronate, 5825 risedronate, and 8464 etidronate) were each matched 1:1 to unexposed patients on glucocorticoid exposure, fracture risk factors, and propensity score. We examined incident hip (primary outcome), vertebral, forearm, and humerus fractures using Cox proportional hazard models. Alendronate (hazard ratio [HR]=0.46, 95% confidence interval [CI] 0.25-0.80) and risedronate (HR=0.58, 95% CI 0.36-0.90) were associated with reduced hip fracture risk. Alendronate (HR= 0.52, 95% CI 0.39-0.68), etidronate (HR=0.59, 95% CI 0.48-0.73) and risedronate (HR=0.47 95% CI 0.36-0.60) were associated with reduced vertebral fracture risk. No risk reduction in forearm or humerus fractures was apparent for any bisphosphonate. Among older chronic glucocorticoid initiators, all oral bisphosphonates reduced vertebral fracture risk, yet only alendronate and risedronate reduced hip fracture risk. Results were similar between men and women. We provided compelling evidence that early initiation of oral bisphosphonates during chronic oral glucocorticoid therapy is beneficial to prevent osteoporotic fractures. (c) 2017 American Society for Bone and Mineral Research.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据