PDF(Pubmed)
Abstract：
Purpose: Patients with osteoporosis are at an increased risk of cardiovascular disease (CVD). Several antiosteoporosis medications have been demonstrated with the benefit of preventing osteoporosis. Our aim is to assess the CVD risks associated with antiosteoporosis medications using the National Health Insurance Research Database in Taiwan between 2000 and 2016. Methods: Among 41,102 patients of 40+ years old with newly diagnosed osteoporosis, 69.1% (N = 28,387) of patients were included in the user cohort of antiosteoporosis medicines, of whom 13, 472 developed CVD by the end of 2016, while 14,915 did not. Using the nested case-control analysis in the user cohort (88.0% women and 77.4% elderly), we applied conditional logistic regression to estimate odds ratios (ORs) of eight types of CVD for the users of denosumab, bisphosphonate, teriparatide, and hormone replacement therapy (HRT). Results: The adjusted ORs of overall CVDs were 0.13 (95% CI: 0.12-0.15) for denosumab users, 0.52 (95% CI: 0.45-0.61) for teriparatide users, and 0.80 (95% CI: 0.76-0.85) for bisphosphonate users. The HRT users were at higher odds of coronary artery and peripheral artery diseases, heart failure, pulmonary embolism, and deep vein thrombosis. Conclusion: Denosumab, teriparatide, and bisphosphonate may have more protective effects against CVD than hormone therapy. Physicians may take subsequent cardiovascular risks into account when choosing an adequate antiosteoporosis medication for patients with osteoporosis.
摘要：
目的：骨质疏松症患者患心血管疾病（CVD）的风险增加。已经证明了几种抗骨质疏松症药物具有预防骨质疏松症的益处。我们的目标是使用2000年至2016年台湾国家健康保险研究数据库评估与抗骨质疏松药物相关的CVD风险。方法:在41102例40岁以上的新诊断骨质疏松症患者中,69.1%(N=28,387)的患者被纳入抗骨质疏松药物的使用者队列，截至2016年底，其中13,472人发展为CVD，而14,915人没有。在用户队列中使用嵌套病例对照分析（88.0％的女性和77.4％的老年人），我们应用条件逻辑回归来估计denosumab用户的八种类型的CVD的优势比（OR），双膦酸盐，特立帕肽,激素替代疗法（HRT）。结果：denosumab使用者的总体CVD的校正OR为0.13（95％CI：0.12-0.15），0.52（95%CI：0.45-0.61），特立帕肽用户，双膦酸盐使用者为0.80（95%CI：0.76-0.85）。HRT使用者患冠状动脉和外周动脉疾病的几率更高，心力衰竭,肺栓塞,深静脉血栓形成.结论：Denosumab，特立帕肽,双膦酸盐可能比激素疗法对心血管疾病有更多的保护作用。在为骨质疏松症患者选择适当的抗骨质疏松症药物时，医生可能会考虑随后的心血管风险。
