| Summary: | 碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 105 === Background:
Hip fracture is common in the geriatric population. Women account for major population. Hip fracture alone was estimated to shorten 11.2 years of lifespan in women, and the primary cause is infection by long-term bedridden. Besides, hip fracture brings huge economic burden for patients and society. The prevalence of ESRD (end-stage renal disease) is more than two thousand people per million population in Taiwan. As by renal function decreased, the risk fracture increased. There are several studies about antiresorptive medications (e.g., alendronate, raloxifene). Nevertheless, the effectiveness of antiresorptive medications in dialysis patients has not be confirmed. The majorities of clinical trials excluded CKD(chronic kidney disease) stage 4 and stage 5 patients, study period is limited and used the surrogate outcome as the clinical outcome which couldn’t reflect the long-term effectiveness of osteoporosis medications.
Study aim:
The objective of this study was to investigate the risk of hospitalization for secondary hip fracture of antiresorptive medications in dialysis women after hip fracture. Also, we explored the risk of mortality among antiresorptive medications users and non-users. Furthermore, we examined the association among risk of hospitalization for secondary hip fracture, the risk of mortality and medication adherence.
Methods:
We used the registry for catastrophic illness database in Taiwan to conduct a retrospective cohort study. We extracted women over 50 years old who newly diagnosed with a hip fracture and under longterm dialysis were enrolled in the period among 2005 to 2011. In the primary analysis, the patients were divided into AR (antiresorptive medications) users and AR nonusers. Then, 1:1 matched on age, the duration of dialysis, and comorbidities and comedications with propensity score. The patients were followed for the occurrence of hospitalization for secondary hip fractures. Also, we examined the 1-year mortality, 2-year mortality between AR users and non-users The Cox regression was used to estimate hazard ratios (HRs) and 95% confidence interval (CI) risk of hospitalization for secondary hip fracture, 1-year mortality, 2-year mortality with potential risk factors adjustment. Furthermore, we would examine the association among medication adherence, risk of hospitalization for secondary hip fracture, and risk of mortality.
Results:
We identified 1079 dialysis patients matched our inclusion criteria in the database. After the matching, there were 74 patients in AR users and nonusers, respectively. There were no significant differences between AR users and nonusers(adjusted Hazard Ratio(aHR):0.60, 95% CI:0.16-2.20) nor between alendronate and raloxifene (aHR:2.76, 95% CI:0.22-35.30) in the incidence of hospitalization for secondary hip fracture after potential risk factors adjustment. There was also no significant difference in the incidence of hospitalization for secondary hip fracture between AR users and nonusers (aHR: 0.66, 95% CI: 0.08-5.66). Furthermore, AR users had the lower 1-year mortality (aHR:0.25, 95% CI:0.07-0.90) and 2-year mortality compared with AR non-users (aHR:0.35, 95% CI: 0.17-0.72). There were no significant differences between AR users or non-users and medication adherence in risk of hospitalization for secondary hip fracture.
Conclusion:
This is the first populationbased study investigated the effectiveness of AR in dialysis women after hip fracture. Our results demonstrated that AR did not significantly improve the risk of hospitalization for secondary hip fracture, but AR users had the lower 1-year mortality rate and 2-year mortality rate than non-users.Suggesting further attentions fit the unmet medical need in dialysis population was warranted.
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