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2型糖尿病患者中噻唑烷二酮类药物的使用与骨折纵向风险之间的关系

Thiazolidenedione Use and the Longitudinal Risk of Fractures in Patients with Type 2 Diabetes Mellitus
Habib ZA, Havstad SL, Wells K   |    2010/4/30 15:16:01   | 
J Clin Endocrinol Metab  |   2010   |          View at Publisher
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Context:
Thiazolidinedione (TZD) use has recently been associated with an increased risk of fractures.

Objective:
The aim of this study was to determine the time-dependent relationship between TZD use and fracture risk.

Design:
We conducted a retrospective cohort study in a large health system in southeast Michigan.

Patients:
Patients who received care from the health system were included if they were at least 18yr of age, had a diagnosis of diabetes, and had at least one prescription for an oral diabetes medication. These criteria identified 19,070 individuals (9,620 women and 9,450 men).

Intervention:
This study compared patients treated with TZDs to patients without TZD treatment. Cox proportional hazard models were used to assess the relationship between exposure and outcomes.

Main Outcome Measures:
The primary outcome was the time to fracture. Secondary analyses examined the risk of fractures in subgroups defined by sex and age.

Results:
TZD use was associated with an increased risk of fracture in the cohort overall [adjusted hazard ratio (aHR), 1.35; 95% confidence interval (CI), 1.05–1.71] and in women (aHR, 1.57; 95% CI, 1.16–2.14), but not in men (aHR, 1.05; 95% CI, 0.70–1.58). Women more than 65yr of age appeared to be at greatest risk for fracture (aHR, 1.72; 95% CI, 1.17–2.52). Among women, the increased fracture risk was not apparent until after 1yr of TZD treatment.

Conclusions:
TZD use was associated with an increased risk for fractures in women, particularly at ages above 65yr. Clinicians should be aware of this association when considering TZD therapy so as to appropriately manage and counsel their patients.
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慢性心衰诊治：规范中求突破
黄峻
2012-2-1
南京医科大学第一附属医院
房颤治疗：手段渐趋丰富 新型治疗药物不断涌现 非药物治疗备受关注
马长生
2012-2-1
首都医科大学附属北京安贞医院
注重老年人群特征 优化管理

刘梅林
2012-2-1
北京大学第一医院老年内科

 
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