TY - JOUR
T1 - Non-steroidal anti-inflammatory drugs and the risk of a second hip fracture
T2 - A propensity-score matching study
AU - Chuang, Po Yao
AU - Shen, Shih Hsun
AU - Yang, Tien Yu
AU - Huang, Tsan Wen
AU - Huang, Kuo Chin
N1 - Publisher Copyright:
© 2016 Chuang et al.
PY - 2016/5/4
Y1 - 2016/5/4
N2 - Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for elderly patients, particularly after a hip fracture. However, we are not clear about the effect of NSAIDs on the risk of a second hip fracture because of confounding factors. Methods: This was a Taiwan National Health Insurance Research Database-based study using propensity-score matching (PSM) to control for confounding. Enrollees were selected from patients with a hip fracture during 1996-2004 and followed longitudinally until December 2009. After PSM for comorbidities and bisphosphonate therapy, 94 patients with a second hip fracture were assigned to the Cases group and 461 without it to the Controls group. The target drugs are NSAIDs; paracetamol and dexamethasone are used for comparison. Results: The correlation between the mean daily-dose (MDD) ratios of NSAIDs and the probability values of the current statistical tests were highly negative (Pearson's r = -0.920, P = 0.003), which indicated that the higher the MDD ratios, the greater the risks of a second hip fracture. A Kaplan-Meier survival analysis showed a time-dependent trend of increasing risk of a second hip fracture in patients taking NSAIDs (P < 0.001). Moreover, patients ≥60 years old had a higher risk of a second hip fracture than did those <60 and taking the NSAIDs diclofenac (P = 0.016) and celecoxib (P = 0.003) and the corticosteroid dexamethasone (P = 0.018), but not those taking analgesic paracetamol (P = 0.074). Conclusions: We conclude that taking NSAIDs after a fragility hip fracture dose- and time-dependently significantly increases the risk of a second hip fracture, especially in elderly patients. To lower the risk of a second hip fracture, any underlying causes for excessively using NSAIDs should be treated and thus fewer NSAIDs prescribed after a first hip fracture.
AB - Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for elderly patients, particularly after a hip fracture. However, we are not clear about the effect of NSAIDs on the risk of a second hip fracture because of confounding factors. Methods: This was a Taiwan National Health Insurance Research Database-based study using propensity-score matching (PSM) to control for confounding. Enrollees were selected from patients with a hip fracture during 1996-2004 and followed longitudinally until December 2009. After PSM for comorbidities and bisphosphonate therapy, 94 patients with a second hip fracture were assigned to the Cases group and 461 without it to the Controls group. The target drugs are NSAIDs; paracetamol and dexamethasone are used for comparison. Results: The correlation between the mean daily-dose (MDD) ratios of NSAIDs and the probability values of the current statistical tests were highly negative (Pearson's r = -0.920, P = 0.003), which indicated that the higher the MDD ratios, the greater the risks of a second hip fracture. A Kaplan-Meier survival analysis showed a time-dependent trend of increasing risk of a second hip fracture in patients taking NSAIDs (P < 0.001). Moreover, patients ≥60 years old had a higher risk of a second hip fracture than did those <60 and taking the NSAIDs diclofenac (P = 0.016) and celecoxib (P = 0.003) and the corticosteroid dexamethasone (P = 0.018), but not those taking analgesic paracetamol (P = 0.074). Conclusions: We conclude that taking NSAIDs after a fragility hip fracture dose- and time-dependently significantly increases the risk of a second hip fracture, especially in elderly patients. To lower the risk of a second hip fracture, any underlying causes for excessively using NSAIDs should be treated and thus fewer NSAIDs prescribed after a first hip fracture.
KW - Fragility hip fracture
KW - Non-steroidal anti-inflammatory drugs
KW - Population-based study
KW - Propensity-score matching
KW - Second hip fracture
UR - http://www.scopus.com/inward/record.url?scp=84978998650&partnerID=8YFLogxK
U2 - 10.1186/s12891-016-1047-2
DO - 10.1186/s12891-016-1047-2
M3 - 文章
C2 - 27141945
AN - SCOPUS:84978998650
SN - 1471-2474
VL - 17
JO - BMC Musculoskeletal Disorders
JF - BMC Musculoskeletal Disorders
IS - 1
M1 - 201
ER -