僵直性脊椎炎病人罹患脊椎及髖骨骨折的危險因子相關研究

Risk of spinal and hip fractures in patients with ankylosing spondylitis: a nationwide population-based study in Taiwan

目的：僵直性關節炎會增加患者的骨折風險，本研究探討僵直性脊椎炎病人族群中脊椎及髖骨骨折之發生率、風險因子及對相關治療之反應。
方法：本研究以台灣國家健康保險研究資料庫之索引資料為本，匯出於2006至2017年間取得僵直性脊椎炎診斷之患者與無病史之對照組。針對骨折發生的時間-事件分析，使用Cox比例風險模型分析僵直性脊椎炎患者相對於對照組在脊椎及髖骨骨折的發生率比(IRR)及風險比(aHR)，並且針對年齡、性別、共病與並用藥物進行調整。
結果：本研究共納入87,248位僵直性脊椎炎病人。在追蹤期間內，此族群與對照組相比有較高的風險罹患脊椎骨折(aHR 1.97, 95% CI 1.91 - 2.17, P < 0.0001)，但髖骨骨折的風險並未顯著增加(aHR 0.97, 95% CI 0.98 - 1.16, P > 0.05)，發生脊椎骨折相關的風險因子包含女性及高齡。接受過非類固醇抗發炎藥(NSAID)治療的僵直性脊椎炎患者，其出現脊椎骨折的風險較未使用者為低(aHR 0.31, 95% CI 0.27 - 0.35)。
結論：僵直性脊椎炎病人出現脊椎骨折的風險顯著上升，非類固醇抗發炎藥之治療能有效降低骨折的發生率。

Objective: Patients with ankylosing spondylitis (AS) suffered from an increased risk of fracture during the disease course, causing severe disability and functional impairment. We aimed to study the prevalence and risk factors of spinal fracture and hip fracture of the AS population in Taiwan.
Methods: This population-based, retrospective cohort study used claim-based National Health Insurance dataset from 2006 to 2017, identifying newly diagnosed patients with AS. The risk of developing spinal and hip fracture in the AS group was compared with those of an age- and sex-matched non-AS group. For the time-event analysis of fracture occurrence, the Cox proportional hazards model was used to analyze the incidence ratio (IRR) and hazard ratio (aHR) of spine and hip fractures in patients with ankylosing spondylitis compared with the control group, while adjusting for age, sex, comorbidities and concomitant medication.
Results: 87,248 eligible patients newly diagnosed of AS were matched with a non-AS control group during the study period. The AS group had a higher risk of developing spinal fracture than the non-AS control with the adjusted hazard ratio (aHR) being 1.97 (95% CI 1.91 - 2.17, P < 0.0001), however the risk of developing hip fracture was not significantly increased (aHR 0.97, 95% CI 0.98 - 1.16, P > 0.05). Risk factors for spinal fracture in the AS group were advanced age and female sex. Patients ever treated with anti-tumor necrosis factor agents (Anti-TNF) or sulfasalazine showed no statistical difference in the risk of developing spinal fracture compared with non-users (aHR 0.94, 95% CI 0.67 - 1.31, P > 0.05; aHR 0.96, 95% Cl 0.85 - 1.08, P > 0.05, respectively), but non-steroidal anti-inflammatory drugs (NSAIDs) ever-users had a significantly decreased risk of spinal fracture compared with non-NSAID users (aHR 0.31, 95% CI 0.27 - 0.35, P < 0.0001).
Conclusions: Patients with AS had a higher risk of spinal fracture compared with the control group. NSAIDs show a protective effect on the development of spinal fracture in patients with AS.