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目的确定骨质疏松治疗[二膦酸盐(BP)、激素疗法(HT)、钙和(或不和)维生素D(CaD)]对死亡率的影响。方法采用前瞻性队列研究,选取1989年4月—2007年5月澳大利亚达博市社区老年骨质疏松患者(年龄>60岁)为受试者,其中男819例,女1 223例。治疗:325例女性(BP,n=106;HT,n=77;CaD,n=142)和37例男性(BP,n=15;CaD,n=22)。结果女性患者,与不做治疗者的死亡率3.5/100人年相比,BP组的0.8/100人年及HT组的1.2/100人年明显降低,但不含CaD组的3.2/100人年无明显降低。不同年龄、骨折发生部位、并存病、四头肌肌力和骨密度患者BP组[HR 0.3(0.2,0.6)]死亡率有所下降,但HT组[HR 0.8(0.4,1.8)]无明显不同。429例女性骨折患者,BP组死亡率有所下降,但再发性骨折发生率无明显降低。男性患者,与不做治疗者的死亡率4.3/100人年相比,BP组的1.0/100人年有所下降,但不含CaD组的3.1/100人年无明显降低。结论骨质疏松性骨折与早死亡相关,抗骨吸收治疗可减少女性或男性死亡风险。
Objectives To determine the effect of osteoporosis therapy on the mortality rate of bisphosphonates (BP), hormonal therapies (HT), calcium and (or not) vitamin D (CaD). Methods A prospective cohort study was conducted. From April 1989 to May 2007, elderly osteoporosis patients (aged> 60 years) from community in Dabo, Australia were enrolled. Among them, 819 were male and 1223 were female. Treatment: 325 women (BP, n = 106; HT, n = 77; CaD, n = 142) and 37 males (BP, n = 15; CaD, n = 22). Results In female patients, 0.8 / 100 for the BP group and 1.2 / 100 for the HT group were significantly lower in the BP group than in the 3.5 / 100 for the non-treated group, but 3.2 / 100 in the CaD-free group No significant reduction in years. In the BP group [HR 0.3 (0.2,0.6)], the death rate was lower in patients of different ages, fractures, comorbidities, quadriceps muscle strength and bone mineral density, but there was no significant difference in HR group [HR 0.8 (0.4,1.8)] different. 429 cases of female fracture patients, BP group mortality decreased, but no significant reduction in the incidence of recurrent fractures. In males, the 1.0 / 100-year decline in the BP group compared with the 4.3 / 100-year mortality rate in non-treatment-free subjects did not show a significant decrease in 3.1 / 100-year rates in the CaD-free group. Conclusions Osteoporotic fractures are associated with early death and anti-bone resorption therapy may reduce the risk of female or male death.