骨质疏松症患者可以长寿


  【24drs.com】根据一篇新的观察型研究,75岁以下女性以及60岁以下男性,开始治疗骨质疏松之后,预期可以存活至少15年以上。
  
  研究者表示,这个结果强调,必须有针对这类状况之患者的长期处置指引。
  
  丹麦Glostrup医院老化与骨质疏松研究中心的Bo Abrahamsen博士等人,在2月7日的骨骼与矿物质研究期刊发表他们的研究结果。
  
  Abrahamsen博士表示,我们从许多研究得知,因为骨质疏松而骨折的病患,死亡率风险增加,特别是脊椎或髋骨骨折。
  
  他本来的预期是,进行骨质疏松治疗的患者会减少余命,即便有适当的治疗也是,[因为]在丹麦,开始骨质疏松治疗的年龄是70岁;所以,预期有15年余命的病患数不多。
  
  骨质疏松是常见的疾病,每年在美国约引起200万例骨折,欧盟则是有350万例,一般都认为骨质疏松骨折患者的死亡率会增加,但是,比较不清楚有骨质疏松但无骨折者的存活率是否有影响。
  
  作者们写道,骨质疏松的长期治疗对医师来说是个挑战,我们对于骨质疏松的第一线用药还未充分了解。
  
  他们解释,治疗年长者的最大障碍是与死亡风险竞赛,然而,如果因为担心死亡风险而减少治疗则是不理性的;若缺乏有关接受治疗患者之预期余命的确切信息,很难订出处置骨质疏松的长期策略与目标。
  
  为了要厘清这个议题的更多信息,研究者使用了丹麦国家资料库追踪骨质疏松药物处方、共病症状况与死亡。他们纳入在1996-2003年开始骨质疏松治疗的58,637名病患,以及225,084名年龄性别相仿的对照组。研究者从2013年开始检索死亡信息,追踪期为10-17年。
  
  在80岁以下男性与60岁以下女性,进行骨质疏松治疗后的第一年内,死亡的相对风险显著高于对照组,但是在后面几年时,逐渐下降到一个稳定而仅略高的程度。
  
  65-70岁以上的妇女,在骨质疏松治疗后的第一年,死亡率风险只有小幅上升,之后,死亡率风险与对照组类似或略低。
  
  在50岁开始治疗骨质疏松的男性的余命为18.2年、在75岁开始治疗的男性为7.5年;在50岁和75岁开始治疗骨质疏松的女性的余命分别是26.4年和13.5年。
  
  Abrahamsen博士表示,对于发现骨质疏松病患即使有治疗仍死亡率增加,我并不感到意外,但是,也确实发现进行骨质疏松治疗的病患存活达15年或更久,而女性优于男性。
  
  不过,他与研究同僚观察发现,我们在这个观察型研究并未做出推论,骨质疏松症的死亡率增加是否可以藉由内科治疗而改善。
  
  相反的,这篇研究中的死亡率是真实世界的观察结果,反映出疾病与介入的总和影响。
  
  Abrahamsen博士表示,目前的研究显示,我们治疗的病患大多数都有长的余命。我们不能沾沾自喜,需要建立一套对每个病人治疗骨质疏松症的长远计划。
  
  目前的治疗指引对于开始骨质疏松治疗有相当清楚的准则,但是对于暂停、结束、改变、或再度开始治疗的指引都只是刚起步。
  
  他结论表示,这是一个真正的挑战,我们需要帮助已经治疗10年或15年的许多病患。
  
  资料来源:http://www.24drs.com/
  
  Native link:Patients With Osteoporosis Can Live Long Lives

Patients With Osteoporosis Can Live Long Lives

By Troy Brown, RN
Medscape Medical News

Women younger than 75 years and men under 60 years can expect to live at least 15 more years after beginning treatment for osteoporosis, according to a new observational study.

The results highlight the need for guidelines for the long-term management of patients with this condition, the researchers say.

Bo Abrahamsen, MD, PhD, from the Research Center for Aging and Osteoporosis, Glostrup Hospital, Denmark, and colleagues report their findings February 7 in the Journal of Bone and Mineral Research.

"We knew from a number of studies that patients with bone fractures due to osteoporosis have much increased risk of mortality, especially after a spine or hip fracture," Dr Abrahamsen told Medscape Medical News.

"My expectation was that patients on osteoporosis treatment would have reduced life expectancy, even with appropriate treatment, [because] the average age at the time of starting osteoporosis treatment in Denmark is about 70 years," he explained. So "the number of patients who had a life expectancy of 15-plus years was believed to be low," he added.

Long-Term Treatment Strategies Lacking

Osteoporosis is a common disease that causes two million fractures in the United States and 3.5 million in the European Union every year. It is widely accepted that patients with osteoporotic fractures experience increased mortality, but what is less clear is whether survival is affected in patients with osteoporosis who have not suffered a fracture.

"Long-term treatment of osteoporosis is challenging to the clinician, as long-term effects of our front-line osteoporosis drugs remain incompletely understood," the authors write.

"The competing risk of death may be a barrier to treating the oldest, yet this may not be rational if the risk of death is reduced by treatment. It is difficult to devise goal-directed long-term strategies for managing osteoporosis without firm information about residual lifetime expectancy in treated patients," they explain.

Outlook "Better in Women Than in Men"

To try to further inform this topic, the researchers used data from Danish national registries to track prescriptions for osteoporosis drugs, comorbid conditions, and deaths. They included 58,637 patients who began osteoporosis treatment from 1996 to 2003 and 225,084 control participants matched for age and gender. The researchers retrieved information on deaths through 2013, which allowed for a follow-up period of 10 to 17 years.

In men younger than 80 years and women younger than 60 years, the relative risk of death was strongly increased during the first year of treatment for osteoporosis relative to controls but then declined to a stable but elevated level in later years.

Women older than 65 to 70 years experienced only a small increase in mortality risk during the first year of treatment followed by a mortality risk similar to or lower than that in the control group.

The residual life expectancy was 18.2 years for men beginning osteoporosis treatment at age 50 years and 7.5 years for men beginning treatment at age 75 years. The residual life expectancy was 26.4 years and 13.5 years for women who began treatment at ages 50 years and 75 years, respectively.

"I was not surprised to find that patients with osteoporosis had increased mortality despite treatment, but it was reassuring to find that most patients who were treated for osteoporosis lived for 15 years or longer, although the outlook was a lot better in women than in men," Dr Abrahamsen told Medscape Medical News.

However, "we do not make inferences in this observational study as to whether excess mortality in osteoporosis was attenuated by medical treatment," he and his colleagues observe.

"Rather, the mortality in the study is a real-world observation that reflects the combined effect of disease and intervention."

Long-Term Guidelines "Are Only Just Being Developed"

"The present study shows that most of the patients we treat have a long life expectancy. We can't be complacent about the need for developing a long-term plan for osteoporosis treatment in each patient," Dr Abrahamsen said.

"Current treatment guidelines are fairly clear about the criteria for starting osteoporosis treatment, but the guidelines for pausing, ending, changing, or restarting treatment are only just being developed."

"This is a real challenge when we all meet a large number of patients who have already had treatment for 10 or 15 years," he concluded.

Dr Abrahamsen has received research grants from or served as an investigator in studies for Novartis, Nycomed/Takeda, NPS Pharmaceuticals, and Amgen. He has in the past served as a national advisory board member for Nycomed/Takeda, Merck, and Amgen and received speaker's fees from Nycomed/Takeda, Amgen, Merck, and Eli Lilly. Disclosures for the coauthors are listed in the article.

J Bone Miner Res. Published online February 7, 2015.

    
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