- 學位論文
服用抑制胃酸分泌藥物與發生髖骨骨折危險之相關
Use of Acid-Suppression Medication and Risk of Hip Fracture
摘要
背景：抑制胃酸分泌藥物，像是H2接受器拮抗劑(H2RAs)與質子幫浦抑制劑(PPIs)，是最普遍使用的藥物之一。在多種低創傷骨折中，髖骨骨折所造成的結果是最嚴重的。PPIs可能藉由胃酸過少而妨礙鈣吸收，但也可能藉由抑制破骨細胞氫離子幫浦而減少骨骼再吸收。在先前研究中，服用抑制胃酸分泌藥物與髖骨骨折之間的相關有著不一致的研究結果。 目的：探討服用抑制胃酸分泌藥物與發生髖骨骨折危險之相關 材料與方法：使用臺灣全民健康保險研究資料庫進行病例對照研究，研究對象排除條件為：(1)在Index date 年齡小於50歲 (2)在Index date之前有骨折病史 (3)在Index date之前有特定之手術處置。病例組包含2005年至2006年所有新發髖骨骨折病例，每位病例皆從同樣的研究族群中隨機抽樣一位匹配對照，匹配其性別、年齡(±3 歲)及Index date (±3天)。 研究結果：本研究匹配了1,241對新發髖骨骨折病例與對照。控制其他藥物服用後(模式一)，發生髖骨骨折的危險與服用PPIs有關(AOR: 1.41; 95% CI: 1.10-1.81)。控制合併症後(模式二)，發生髖骨骨折的危險與服用PPIs有關(AOR: 1.43; 95% CI: 1.13-1.81)。服用高劑量PPIs 會顯著地增加發生髖骨骨折的危險。發生髖骨骨折的危險隨著服用PPIs劑量增加而提高，服用低劑量PPIs發生髖骨骨折的危險是沒有服用的 0.87倍(95% CI: 0.58-1.30)；中劑量為 1.37倍 (95% CI: 0.88-2.15)；高劑量為 2.13倍 (95% CI: 1.44-3.15)，有顯著的劑量反應效應。發生髖骨骨折的危險與服用H2RAs無關。 結論：累積服用高劑量PPIs(>70 DDDs)會增加發生髖骨骨折的危險。
並列摘要
Background: Acid-suppression medications, such as histamine type 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), have become one of the most commonly prescribed classes of therapeutic agents. Among the various forms of low-trauma fractures, hip fracture leads to the most devastating consequences. PPIs may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps. Among previous studies, the association between acid-suppressive medication use and hip fracture is inconsistency. Objective: To investigate the association between acid-suppressive medication and risk of hip fracture. Material and methods: A case-control study was conducted using the National Health Insurance Research Database (NHIRD). The individuals were excluded from the study if they met at least one of the following criteria: (1) younger than 50 years at the index date; (2) had a documented fracture before the index date; (3) had a procedure of specific operations before the index date. Cases included all patients with an incident hip fracture between January 2005 and December 2006. For each case, one control without any fracture was matched of age (±3 year), gender, and index date (±3 day), and selected by random sampling from the background population. Results: We matched 1,241 pairs of incident hip fracture cases and controls. Controlling only for other medications (model I), the adjusted odds ratio (AOR) for hip fracture associated with PPI therapy was 1.41 (95% CI: 1.10-1.81). Controlling only for co-morbidities (model Ⅱ), AOR for hip fracture associated with PPI therapy was 1.43 (95% CI: 1.13-1.81). The risk of hip fracture was significantly increased among patients prescribed high-dose PPIs. The strength of the association increased with increasing dose of PPI therapy [AOR for low-dose: 0.87(95% CI: 0.58-1.30); median-dose: 1.37(95% CI: 0.88-2.15); high-dose: 2.13(95% CI: 1.44-3.15); test for trend, p=0.002]. There was no association between H2RAs therapy and risk of hip fracture. Conclusion: Use of high-dose PPIs (>70 DDDs) is associated with an increased risk of hip fracture.