背景:长期使用质子泵抑制剂(PPI)与骨脆性增加有关。然而,关于长期使用PPI对骨密度影响的证据是相互矛盾的,关于骨骼微建筑质量的数据很少。
目的:本研究的主要目的是评估骨小梁微结构,通过骨小梁评分(TBS)评估,在慢性PPI使用者中发生了变化。PPI使用与骨密度之间的关联也被评估为次要终点。
方法:我们从基于人群的国家健康和营养调查(NHANES)的2005-2008周期中提取了个体患者数据,其中获得了腰椎双能X线骨密度仪(DXA)扫描。使用专用软件从DXA图像计算TBS值。进行了按性别分层的多变量线性回归分析,以评估长期使用PPI与TBS和骨密度(BMD)的关系。调整相关的混杂因素。
结果:共纳入7478名受试者(3961名男性,3517名妇女)。在调整相关混杂因素后,长期使用PPI与男性骨骼健康状况恶化有关,具有较低的TBS(-0.039,95CI:[-0.058,-0.020],p<0.001),腰椎T评分(-0.27,95CI:[-0.49,-0.05],p=0.018),总髋关节T评分(-0.20,95CI:[-0.39,-0.01],p=0.038),股骨颈T评分(-0.21,95CI:[-0.42,-0.01],p=0.045)。值得注意的是,即使进一步调整腰椎和股骨颈的BMD后,长期使用PPI与TBS降解之间的关联仍具有统计学意义(-0.026,95CI:[-0.039,-0.012],p=0.001)。相比之下,在女性患者中,长期使用PPI与TBS或BMD均无显著关联.
结论:长期使用PPI与男性骨小梁质量下降有关,即使在调整BMD后。在女性中未观察到关联。
BACKGROUND: Chronic use of proton pump inhibitors (PPIs) has been associated with an increase in bone fragility. However, evidence on the effect of chronic PPI use on bone density is conflicting, and data on bone microarchitectural quality are scarce.
OBJECTIVE: The primary aim of this study was to evaluate whether trabecular bone microarchitecture, assessed by trabecular bone score (TBS), is altered in chronic PPI users. The association between PPI use and bone density was also evaluated as a secondary endpoint.
METHODS: We extracted individual patient data from the 2005-2008 cycles of the population-based National Health and Nutrition Examination Survey (NHANES), in which lumbar spine dual-energy X-ray absorptiometry (DXA) scans were acquired. TBS values were calculated from DXA images using a dedicated software. Multivariable linear regression analyses stratified by sex were performed to evaluate the association of chronic PPI use with TBS and bone mineral density (BMD), adjusting for relevant confounders.
RESULTS: A total of 7478 subjects were included (3961 men, 3517 women). After adjustment for relevant confounders, chronic PPI use was associated with a worse bone health profile in men, with lower TBS (-0.039, 95%CI:[-0.058, -0.020], p<0.001), lumbar spine T-score (-0.27, 95%CI:[-0.49, -0.05], p=0.018), total hip T-score (-0.20, 95%CI:[-0.39, -0.01], p=0.038), and femoral neck T-score (-0.21, 95%CI:[-0.42, -0.01], p=0.045). Notably, the association between chronic PPI use and degraded TBS remained statistically significant even after further adjustment for BMD at lumbar spine and femoral neck (-0.026, 95%CI:[-0.039, -0.012], p=0.001). In contrast, no significant association was observed between chronic PPI use and either TBS or BMD in women.
CONCLUSIONS: Chronic PPI use is associated with degraded trabecular bone quality in men, even after adjustment for BMD. No association was observed in women.