在这项基于人群的大型匹配队列研究中,原发性醛固酮增多症患者髋部骨折的风险增加,特别是传统上认为骨质疏松症风险较高的亚组,如女性,诊断时年龄超过56岁的患者,确诊时患有心血管疾病的患者,和接受MRA治疗的患者。
目的:先前的研究表明原发性醛固酮增多症(PA)与骨稳态失调有关。这项研究的目的是评估PA患者髋部骨折的发生率。
方法:我们研究了来自普通人群的2419名PA患者(1997-2019)和24.187名年龄和性别匹配的对照的全国队列。通过瑞典国家患者登记册中的ICD代码识别髋部骨折。我们估计了髋部骨折的危险比(HR),根据先前的骨折进行调整,社会经济因素,糖尿病,骨质疏松,甲状旁腺功能亢进,心血管疾病(CVD)。按年龄(18-56岁和>56岁)进行配对亚组比较,性别,基线时的CVD,治疗PA。
结果:在8±5年的平均随访期间,64例(2.6%)患者在被诊断为PA后发生髋部骨折,与401(1.7%)对照相比。调整后,与对照组相比,PA与髋部骨折风险增加55%相关(HR1.55[1.18-2.03])。女性的HR增加(HR1.76[95%CI1.24-2.52]),年龄>56岁的患者(HR1.62[95%CI1.21-2.17]),和诊断时患有CVD的患者(HR2.15[95%CI1.37-3.37])。使用肾上腺切除术治疗的PA患者的风险并不比对照组高(HR0.84[95%CI0.35-2.0]),而接受盐皮质激素受体拮抗剂(MRA)治疗的患者仍有较高的风险(HR1.84[95%CI1.20-2.83]).
结论:PA与髋部骨折风险增加相关,尤其是女性,年龄在56岁后诊断的患者和诊断时已确诊的CVD患者。此外,接受MRA治疗的患者患髋部骨折的风险增加,而肾上腺切除术可能是保护性的。
In this large population-based matched cohort
study, patients with primary aldosteronism were at increased risk of hip fracture, particularly subgroups traditionally considered at higher risk of osteoporosis such as women, patients older than 56 years at diagnosis, patients with established cardiovascular disease at diagnosis, and patients treated with MRA.
OBJECTIVE: Previous studies suggest that primary aldosteronism (PA) is associated with dysregulated bone homeostasis. The aim of this
study was to evaluate the incidence of hip fractures in patients with PA.
METHODS: We studied a nationwide cohort of 2419 patients with PA (1997-2019) and 24 187 age and sex matched controls from the general population. Hip fractures were identified by ICD codes in the Swedish National Patient Register. We estimated hazard ratios (HRs) for incident hip fractures, adjusted for prior fractures, socioeconomic factors, diabetes, osteoporosis, hyperparathyroidism, and cardiovascular disease (CVD). Pairwise subgroup comparisons were performed by age (18-56 and > 56 years), sex, CVD at baseline, and treatment for PA.
RESULTS: During a mean follow up of 8 ± 5 years, 64 (2.6%) patients had a hip fracture after being diagnosed with PA, compared to 401 (1.7%) controls. After adjustments, PA was associated with a 55% increased risk of hip fracture compared to controls (HR 1.55 [1.18-2.03]). HRs were increased in women (HR 1.76 [95% CI 1.24-2.52]), patients aged > 56 years (HR 1.62 [95% CI 1.21-2.17]), and patients with CVD at diagnosis (HR 2.15 [95% CI 1.37-3.37]). PA patients treated with adrenalectomy did not have higher risk than controls (HR 0.84 [95% CI 0.35-2.0]), while patients treated with mineralocorticoid receptor antagonists (MRA) retained a greater risk (HR 1.84 [95% CI 1.20-2.83]).
CONCLUSIONS: PA is associated with increased hip fracture risk, especially in women, patients diagnosed after the age of 56 years and patients with established CVD at diagnosis. Also, patients treated with MRA seem to have an increased risk of hip fractures, while adrenalectomy may be protective.