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BMJ:当前研究支持使用阿仑膦酸钠治疗骨质疏松可降低骨折的发生风险

2016-06-29 MedSci MedSci原创

本研究旨在确定骨质疏松症患者长期(≥10年)使用阿仑膦酸钠的骨骼安全性和疗效。研究共纳入了61990名男性及女性,开始接受治疗时的年龄为50-94岁,但是先前并未服用阿仑膦酸钠。主要研究结果为股骨转子下或股骨干(ST / FS)或髋关节骨折。非骨折对照组患者匹配了性别,出生年份,以及使用阿仑膦酸钠治疗的起始年。使用条件逻辑回归模型计算校正及未校正并发症和联合用药的比值比。使用敏感性分析探究与其他药

本研究旨在确定骨质疏松症患者长期(≥10年)使用阿仑膦酸钠的骨骼安全性和疗效。

研究共纳入了61990名男性及女性,开始接受治疗时的年龄为50-94岁,但是先前并未服用阿仑膦酸钠。

主要研究结果为股骨转子下或股骨干(ST / FS)或髋关节骨折。非骨折对照组患者匹配了性别,出生年份,以及使用阿仑膦酸钠治疗的起始年。使用条件逻辑回归模型计算校正及未校正并发症和联合用药的比值比。使用敏感性分析探究与其他药物联合治疗骨质疏松症的后续情况。

结果共有1428参与者发生ST / FS(发病率3.4/1000人年),6784名参与者髋部骨折(发病率16.2/1000人年)。与治疗依从性较差的患者相比,治疗依从性较高的患者ST / FS的风险较低。校正多变量后该关联的强度减弱。与既往使用阿仑膦酸钠的患者相比,当前使用阿仑膦酸钠的患者及长期使用阿仑膦酸钠的患者骨折的发生风险并未升高。同样,药物持有率MPR大于80%(使用5-10年或≥10年)与髋部骨折的风险降低相关。

这些发现支持在骨折疗效方面,使用阿仑膦酸钠治疗的益处及弊处处于一个可接受的平衡中,甚至连续使用超过10年也是如此。

原始出处:

Bo Abrahamsen, Pia Eiken, et al., Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate: nationwide cohort and nested case-control study. BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i3365.


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  1. [GetPortalCommentsPageByObjectIdResponse(id=1848031, encodeId=89fd18480319f, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu May 18 14:44:00 CST 2017, time=2017-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129409, encodeId=16ec1294091a, content=不错哦,会学到很多,喜欢梅斯医学文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sat Sep 17 11:44:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107380, encodeId=b4a810e38010, content=好文,值得学习,赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Aug 30 11:17:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497656, encodeId=ace5149e65656, content=<a href='/topic/show?id=68b49e70922' target=_blank style='color:#2F92EE;'>#阿仑膦酸钠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97709, encryptionId=68b49e70922, topicName=阿仑膦酸钠)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Jul 01 13:44:00 CST 2016, time=2016-07-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592331, encodeId=e49b1592331b1, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Fri Jul 01 13:44:00 CST 2016, time=2016-07-01, status=1, ipAttribution=)]
    2017-05-18 gaoxiaoe
  2. [GetPortalCommentsPageByObjectIdResponse(id=1848031, encodeId=89fd18480319f, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu May 18 14:44:00 CST 2017, time=2017-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129409, encodeId=16ec1294091a, content=不错哦,会学到很多,喜欢梅斯医学文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sat Sep 17 11:44:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107380, encodeId=b4a810e38010, content=好文,值得学习,赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Aug 30 11:17:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497656, encodeId=ace5149e65656, content=<a href='/topic/show?id=68b49e70922' target=_blank style='color:#2F92EE;'>#阿仑膦酸钠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97709, encryptionId=68b49e70922, topicName=阿仑膦酸钠)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Jul 01 13:44:00 CST 2016, time=2016-07-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592331, encodeId=e49b1592331b1, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Fri Jul 01 13:44:00 CST 2016, time=2016-07-01, status=1, ipAttribution=)]
    2016-09-17 1e10c84am36(暂无匿称)

    不错哦,会学到很多,喜欢梅斯医学文章

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1848031, encodeId=89fd18480319f, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu May 18 14:44:00 CST 2017, time=2017-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129409, encodeId=16ec1294091a, content=不错哦,会学到很多,喜欢梅斯医学文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sat Sep 17 11:44:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107380, encodeId=b4a810e38010, content=好文,值得学习,赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Aug 30 11:17:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497656, encodeId=ace5149e65656, content=<a href='/topic/show?id=68b49e70922' target=_blank style='color:#2F92EE;'>#阿仑膦酸钠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97709, encryptionId=68b49e70922, topicName=阿仑膦酸钠)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Jul 01 13:44:00 CST 2016, time=2016-07-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592331, encodeId=e49b1592331b1, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Fri Jul 01 13:44:00 CST 2016, time=2016-07-01, status=1, ipAttribution=)]
    2016-08-30 ylzr123

    好文,值得学习,赞!

    0

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    2016-07-01 Eleven17

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众所周知BMI和运动是绝经后妇女的骨折危险因素,不过最近有研究表明,不同部位的骨折风险很大变化。多伦多大学运动机能学和体育教育的Jason Lacombe和同事对1,154,821女性(纳入研究时平均56岁)的数据进行了分析。通过问卷调查妇女提供健康和生活方式相关数据;平均随访11年。研究人员使用了Cox回归模型计算调整后的7个部位的绝对和相对骨折风险。在随访过程中,发生了4931例肱骨、2926

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患者男,72岁,因左手腕自发性骨折就诊。查体:患者的右手腕也有骨折。无淋巴结肿大。X片:骨折的尺骨远端广泛的溶骨性病变(如下图)。患者否认体重减轻、盗汗、前列腺问题等。PET:胸腹部未见原发性肿瘤,也没有发现其他骨骼病变,前列腺癌也不考虑。左尺骨活检:弥漫性大B细胞淋巴瘤。骨髓涂片和活检:未见恶性细胞。诊断:原发性骨质弥漫性大B细胞淋巴瘤 IIE期。治疗:3个周期的R-CHOP方案(利妥昔单抗治疗

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对于原发性甲状旁腺功能亢进症(PHPT),手术和药物治疗对于骨折的风险差别是未知的。该研究的目的是评估在PHPT患者中,甲状旁腺切除和双膦酸盐治疗对于这些患者骨骼的结果。该回顾性队列研究在一家集成医疗服务体系中进行,所有的参与者均为在1995到2010年期间确诊为PHPT的患者。检测主要指标为骨密度变化与骨折发生率。在2013例经过一些列骨密度检查的患者中,全髋BMD在甲状旁腺切除(在<2年

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