雙磷酸鹽類藥物使用對骨鬆骨折病人死亡率的影響－
健保資料庫分析
 
許育煊^1,2　李佳純^3,4　梁富文⁵　張尹凡⁴　徐之昇^6*　吳至行^4,7

 
目的：使用骨質疏鬆藥物可降低骨鬆骨折後死亡風險，而台灣相對缺乏本土的巨資料研究，尤其是雙磷酸鹽類藥物的研究更是不足。本研究旨在探討骨鬆骨折後有無使用雙磷酸鹽類藥物對死亡率之影響。
方法：本研究納入2009至2017年全民健康保險資料庫之門診有骨質疏鬆症診斷且有住院骨折住院診斷新發個案，串聯死因統計檔，分析有無使用雙磷酸鹽類藥物對於全死因死亡的風險。
結果：本研究總樣本為149,288人，存活者平均追蹤人年為4.96人年，死亡者為3.15人年。相較於無使用雙磷酸鹽類藥物者，使用雙磷酸鹽類藥物的死亡風險比為0.97 (95% CI 0.95-0.99)。而單獨使用口服alendronate/risedronate的死亡風險比為1.01 (95% CI 0.99-1.03)，針劑ibandronate為0.87 (95% CI 0.81-0.93)，針劑zoledronic acid則為0.74 (95% CI 0.70-0.78)。在髖骨骨折或脊椎骨折的次分析皆有相似結果。
結論：本研究發現骨鬆骨折個案使用雙磷酸鹽類藥物者之整體死亡風險顯著降低，尤其是針劑藥物。此研究結果應可供臨床實務及公共政策之參考。
（台灣家醫誌2021; 31: 199-213）DOI: 10.3966/168232812021093103004
 
關鍵詞：骨質疏鬆症、骨折、死亡率、雙磷酸鹽類藥物
 

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¹國立成功大學醫學院臨床藥學與藥物科技研究所、²藥學系、³健康照護科學研究所、⁷老年學研究所；⁴國立成功大學醫學院附設醫院家庭醫學部；⁵高雄醫學大學健康科學院公共衛生學系；⁶臺北醫學大學管理學院國際生技醫療管理博士學位學程
受理日期：110年1月29日　　修改日期：110年5月13日　　同意刊登：110年8月10日
通訊作者：吳至行　　　　　通訊地址：臺南市北區勝利路138號　E-mail：paulo@mail.ncku.edu.tw
*共同通訊作者：徐之昇　E-mail：jasonhsu@tmu.edu.tw

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Bisphosphonate and Mortality in Patients with
Osteoporotic Fracture: An Analysis based on National
Health Insurance Research Database
 
Yu-Hsuan Hsu^1,2, Chia-Chun Li^3,4, Fu-Wen Liang⁵, Yin-Fan Chang⁴, Jason C. Hsu^6* and
Chih-Hsing Wu^4,7

 
Purpose: While pharmacological intervention does help reduce the risk of total mortality induced by osteoporotic fracture, few studies have been conducted to examine the impact of specific drugs, especially bisphosphonates, on osteoporotic fractures in Taiwan. Therefore, the study aimed to analyze the relationship between the use of bisphosphonates for osteoporotic fractures and resulting mortality.
Methods:The National Health Insurance Research Database (NHIRD), together with the Cause of Death Data, provided by Health and Welfare Data Science Center was consulted for analysis on subjects hospitalized for osteoporotic fracture from 2009 to 2017 to study the connection between the use of bisphosphonates and mortality among patients with osteoporotic fracture.
Results: A total of 149,288 valid participants were enrolled, and the mean follow-up personyears of the survivor and death were respectively 4.96 and 3.15. Compared with those who used no bisphosphonates, the mortality hazard ratio was 0.97 (95% confidence interval, CI 0.95-0.99) for patients receiving bisphosphonates, 1.01 (95% CI 0.99-1.03) for oral alendronate/risedronate, 0.87 (95% CI 0.81-0.93) for ibandronate by injection, and 0.74 (95% CI 0.70-0.78) for zoledronic acid in total fractures. Consistent results were found in subgroup-analysis of hip fractures or spine fractures.
Conclusion:Use of bisphosphonates, especially through injection, appears to be significantly associated with reduced mortality in patients with osteoporotic fractures. The result of this study should be considered in clinical practice and public policy.
(Taiwan J Fam Med 2021; 31: 199-213) DOI: 10.3966/168232812021093103004
 
Key words: bisphosphonate, fractures, mortality, osteoporosis
 

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¹Institute of Clinical Pharmacy and Pharmaceutical Sciences, ²School of Pharmacy, ³Institute of Allied Health Sciences, ⁷Institute of Geriatrics, College of Medicine, National Cheng Kung University, Tainan; ⁴Department of Family Medicine,National Cheng Kung University Hospital, Tainan; ⁵Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung; ⁶International Ph.D. Program in Biotech and Healthcare Management, School of Management, Taipei Medical University, Taipei, Taiwan.
*co-corresponding author
Received: January 29, 2021; Revised: May 13, 2021; Accepted: Auguest 10, 2021.