骨質疏鬆症患者可以長壽


  【24drs.com】根據一篇新的觀察型研究,75歲以下女性以及60歲以下男性,開始治療骨質疏鬆之後,預期可以存活至少15年以上。
  
  研究者表示,這個結果強調,必須有針對這類狀況之患者的長期處置指引。
  
  丹麥Glostrup醫院老化與骨質疏鬆研究中心的Bo Abrahamsen博士等人,在2月7日的骨骼與礦物質研究期刊發表他們的研究結果。
  
  Abrahamsen博士表示,我們從許多研究得知,因為骨質疏鬆而骨折的病患,死亡率風險增加,特別是脊椎或髖骨骨折。
  
  他本來的預期是,進行骨質疏鬆治療的患者會減少餘命,即便有適當的治療也是,[因為]在丹麥,開始骨質疏鬆治療的年齡是70歲;所以,預期有15年餘命的病患數不多。
  
  骨質疏鬆是常見的疾病,每年在美國約引起200萬例骨折,歐盟則是有350萬例,一般都認為骨質疏鬆骨折患者的死亡率會增加,但是,比較不清楚有骨質疏鬆但無骨折者的存活率是否有影響。
  
  作者們寫道,骨質疏鬆的長期治療對醫師來說是個挑戰,我們對於骨質疏鬆的第一線用藥還未充分瞭解。
  
  他們解釋,治療年長者的最大障礙是與死亡風險競賽,然而,如果因為擔心死亡風險而減少治療則是不理性的;若缺乏有關接受治療患者之預期餘命的確切資訊,很難訂出處置骨質疏鬆的長期策略與目標。
  
  為了要釐清這個議題的更多資訊,研究者使用了丹麥國家資料庫追蹤骨質疏鬆藥物處方、共病症狀況與死亡。他們納入在1996-2003年開始骨質疏鬆治療的58,637名病患,以及225,084名年齡性別相仿的對照組。研究者從2013年開始檢索死亡資訊,追蹤期為10-17年。
  
  在80歲以下男性與60歲以下女性,進行骨質疏鬆治療後的第一年內,死亡的相對風險顯著高於對照組,但是在後面幾年時,逐漸下降到一個穩定而僅略高的程度。
  
  65-70歲以上的婦女,在骨質疏鬆治療後的第一年,死亡率風險只有小幅上升,之後,死亡率風險與對照組類似或略低。
  
  在50歲開始治療骨質疏鬆的男性的餘命為18.2年、在75歲開始治療的男性為7.5年;在50歲和75歲開始治療骨質疏鬆的女性的餘命分別是26.4年和13.5年。
  
  Abrahamsen博士表示,對於發現骨質疏鬆病患即使有治療仍死亡率增加,我並不感到意外,但是,也確實發現進行骨質疏鬆治療的病患存活達15年或更久,而女性優於男性。
  
  不過,他與研究同僚觀察發現,我們在這個觀察型研究並未做出推論,骨質疏鬆症的死亡率增加是否可以藉由內科治療而改善。
  
  相反的,這篇研究中的死亡率是真實世界的觀察結果,反映出疾病與介入的總和影響。
  
  Abrahamsen博士表示,目前的研究顯示,我們治療的病患大多數都有長的餘命。我們不能沾沾自喜,需要建立一套對每個病人治療骨質疏鬆症的長遠計劃。
  
  目前的治療指引對於開始骨質疏鬆治療有相當清楚的準則,但是對於暫停、結束、改變、或再度開始治療的指引都只是剛起步。
  
  他結論表示,這是一個真正的挑戰,我們需要幫助已經治療10年或15年的許多病患。
  
  資料來源: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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