PDF(Pubmed)
Abstract：
BACKGROUND: The therapeutic efficacy of renin-angiotensin system inhibitors (RASi) in elderly patients with hypertension and at risk of fractures has been in the limelight because of accumulating evidence that localized RAS activation in bone tissue leads to osteoclastic bone resorption, resulting in osteoporosis. This study set out to investigate the association between RASi use and fracture incidence in a large cohort.
METHODS: We employed a nested case-control design to investigate the association between RASi use and newly developed fractures. A case was defined as a patient newly diagnosed with a fracture between January 2004 and December 2015. We selected 1,049 cases and controls using 1:1 propensity score matching. Conditional logistic regression analysis was conducted to estimate the association between RASi exposure and fracture incidence.
RESULTS: Overall, RASi usage was significantly associated with lower odds for fracture incidence (ever-users vs never-users: OR, 0.73; 95% CI, 0.59-0.91). We found that ARB-only users experienced fewer fractures than RASi-never users (OR, 0.65; 95% CI, 0.49-0.86), whereas ACEi-only users or ARB/ACEi-ever users did not. In subgroup analysis, RASi-ever users without cerebrovascular disease, those with a BMI exceeding 23, and statin exposure had significantly lower ORs.
CONCLUSIONS: The present study established a significant association between RASi use and reduced fracture incidence, thus highlighting the potential clinical utility of RASi use as a preventive strategy in elderly patients at risk for osteoporotic fractures.
METHODS: We employed a nested case-control design to investigate the association between RASi use and newly developed fractures. A case was defined as a patient newly diagnosed with a fracture between January 2004 and December 2015. We selected 1,049 cases and controls using 1:1 propensity score matching. Conditional logistic regression analysis was conducted to estimate the association between RASi exposure and fracture incidence.
RESULTS: Overall, RASi usage was significantly associated with lower odds for fracture incidence (ever-users vs never-users: OR, 0.73; 95% CI, 0.59-0.91). We found that ARB-only users experienced fewer fractures than RASi-never users (OR, 0.65; 95% CI, 0.49-0.86), whereas ACEi-only users or ARB/ACEi-ever users did not. In subgroup analysis, RASi-ever users without cerebrovascular disease, those with a BMI exceeding 23, and statin exposure had significantly lower ORs.
CONCLUSIONS: The present study established a significant association between RASi use and reduced fracture incidence, thus highlighting the potential clinical utility of RASi use as a preventive strategy in elderly patients at risk for osteoporotic fractures.
摘要：
背景：肾素-血管紧张素系统抑制剂（RASi）在老年高血压和有骨折风险的患者中的治疗效果一直备受关注，因为越来越多的证据表明骨组织中的局部RAS激活导致破骨细胞吸收，导致骨质疏松症。本研究旨在调查大型队列中RASi使用与骨折发生率之间的关联。
方法：我们采用嵌套病例对照设计来研究RASi使用与新出现的骨折之间的关联。病例定义为2004年1月至2015年12月期间新诊断为骨折的患者。我们使用1：1倾向评分匹配选择了1,049例病例和对照。进行条件logistic回归分析以估计RASi暴露与骨折发生率之间的关联。
结果：总体而言，RASi的使用与较低的骨折发生率显着相关（曾经使用过的人与从未使用过的人：OR，0.73；95%CI，0.59-0.91）。我们发现，仅使用ARB的用户比从未使用RASi的用户经历更少的骨折(或，0.65；95%CI，0.49-0.86），而仅ACEi的用户或ARB/ACEi曾经的用户则没有。在亚组分析中，RASi-曾经没有脑血管疾病的使用者，BMI超过23且他汀类药物暴露者的OR显著较低.
结论：本研究建立了使用RASi和减少骨折发生率之间的显著关联，因此突出了RASi作为有骨质疏松性骨折风险的老年患者的预防策略的潜在临床实用性。
方法：我们采用嵌套病例对照设计来研究RASi使用与新出现的骨折之间的关联。病例定义为2004年1月至2015年12月期间新诊断为骨折的患者。我们使用1：1倾向评分匹配选择了1,049例病例和对照。进行条件logistic回归分析以估计RASi暴露与骨折发生率之间的关联。
结果：总体而言，RASi的使用与较低的骨折发生率显着相关（曾经使用过的人与从未使用过的人：OR，0.73；95%CI，0.59-0.91）。我们发现，仅使用ARB的用户比从未使用RASi的用户经历更少的骨折(或，0.65；95%CI，0.49-0.86），而仅ACEi的用户或ARB/ACEi曾经的用户则没有。在亚组分析中，RASi-曾经没有脑血管疾病的使用者，BMI超过23且他汀类药物暴露者的OR显著较低.
结论：本研究建立了使用RASi和减少骨折发生率之间的显著关联，因此突出了RASi作为有骨质疏松性骨折风险的老年患者的预防策略的潜在临床实用性。
