背景:目前的临床指南建议延长口服双膦酸盐后休药期。然而,尚无研究调查髋部骨折前药物假期对骨折后死亡率的影响.
目的:探讨药物假期对长期口服双膦酸盐患者骨折后死亡率的影响。
方法:基于人群的回顾性队列研究。
方法:维多利亚州所有髋部骨折患者,澳大利亚2014-18
方法:患者在髋部骨折前坚持口服阿仑膦酸盐或利塞膦酸盐≥5年。
方法:基于小组的轨迹模型将患者在5年良好依从性后分为不同的双膦酸盐使用情况。
方法:骨折后死亡率。
结果:我们确定365名患者口服阿仑膦酸钠/利塞膦酸钠的依从性良好(药物占有率≥80%)≥5年。大多数患者(69%)继续使用口服双膦酸盐,直到髋部骨折入院为止;17%的人停药一年,14%的人停药两年。在髋部骨折前1年(危险比[HR]2.37,95%置信区间[CI]1.24-4.53)和2年(HR3.08,95%CI1.48-6.41)的患者骨折后死亡率较高。在髋部骨折前停用阿仑膦酸钠1年(HR0.59,95%CI0.29-1.18)或2年(HR1.05,95%CI0.57-1.93)的患者中,未观察到骨折后死亡率的升高或降低。
结论:停用利塞膦酸盐的患者骨折后死亡率更高,但不是阿仑膦酸盐,坚持治疗至少5年后1或2年。双膦酸盐的类型可能是计划药物假期时要考虑的因素。
BACKGROUND: Current clinical guidelines recommend a drug holiday after extended use of oral bisphosphonates. However, no studies have investigated the impact of drug holidays before hip fractures on post-fracture mortality.
OBJECTIVE: To investigate the effect of drug holiday on post-fracture mortality in patients with extended use of oral bisphosphonates.
METHODS: Retrospective population-based cohort study.
METHODS: All patients with hip fractures in Victoria, Australia from 2014-18.
METHODS: Patients adherent to oral alendronate or risedronate for ≥5 years prior to hip fracture.
METHODS: Group-based trajectory modelling categorized patients into different bisphosphonate usage after 5-year good adherence.
METHODS: Post-fracture mortality.
RESULTS: We identified 365 patients with good adherence (medication possession ratio ≥80%) to oral alendronate/risedronate for ≥5 years. Most patients (69%) continued to use oral bisphosphonates till admission for hip fracture; 17% had discontinued for one year and 14% had discontinued for two years. Post-fracture mortality was higher in patients who had discontinued risedronate for one year (Hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.24-4.53) and two years (HR 3.08, 95% CI 1.48-6.41) prior to hip fracture. No increase or decrease in post-fracture mortality was observed in patients who had discontinued alendronate for one year (HR 0.59, 95% CI 0.29-1.18) or two years (HR 1.05, 95% CI 0.57-1.93) prior to hip fracture.
CONCLUSIONS: Post-fracture mortality is higher in people who discontinue risedronate, but not alendronate, for 1 or 2 years after being adherent to treatment for at least 5 years. The type of bisphosphonate may be a factor to consider when planning drug holidays.