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Zhang R, Yin H, Yang M, Lei X, Zhen D, Zhang Z. Advanced Progress of the Relationship Between Antihypertensive Drugs and Bone Metabolism. Hypertension 2023; 80:2255-2264. [PMID: 37675564 DOI: 10.1161/hypertensionaha.123.21648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Hypertension and osteoporosis are common comorbidities among elderly individuals. Drug therapy has been widely used in clinical practice as the preferred antihypertensive treatment. Therefore, antihypertensive drugs have become some of the most commonly prescribed drugs in healthcare settings. However, antihypertensive drugs have different effects on bone metabolism. The results of animal and clinical studies on the effects of antihypertensive drugs on osteoporosis or fracture risk are controversial and have aroused widespread concern among clinicians. Recent studies found that angiotensin receptor blockers, selective β-adrenergic receptor blockers, and thiazide diuretics might improve bone trabecular number and bone mineral density by stimulating osteoblast differentiation, reducing osteoclast generation, and other mechanism. Furthermore, nonselective β-adrenergic receptor blockers and dihydropyridine calcium channel blockers were found to have no significant relationship with bone mineral density or bone strength, and α-adrenergic receptor blockers and loop diuretics might increase fracture risk by decreasing bone mineral density. This article aimed to review previous animal experiments, clinical studies, and meta-analyses focusing on the effects of different antihypertensive drugs on bone metabolism, and to provide a new approach for the prevention and treatment of osteoporosis.
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Affiliation(s)
- Ruixing Zhang
- The First Clinical Medical College, Lanzhou University, China (R.Z., M.Y.)
- Department of Heart Center (R.Z., Z.Z.), The First Hospital of Lanzhou University, China
| | - Hongtao Yin
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Mengdi Yang
- The First Clinical Medical College, Lanzhou University, China (R.Z., M.Y.)
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Xianqiong Lei
- Department of Geriatrics, The First People's Hospital of Yibin, China (X.L.)
| | - Donghu Zhen
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Zheng Zhang
- Department of Heart Center (R.Z., Z.Z.), The First Hospital of Lanzhou University, China
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Non-Pharmacological Interventions towards Preventing the Triad Osteoporosis-Falls Risk-Hip Fracture, in Population Older than 65. Scoping Review. J Clin Med 2020; 9:jcm9082329. [PMID: 32707829 PMCID: PMC7463822 DOI: 10.3390/jcm9082329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 02/01/2023] Open
Abstract
Osteoporosis leads to increased risk of falls, and thus an increase in fractures, highlighting here hip fractures, that result in high mortality, functional disability, and high medical expenditure. The aim is to summarise the available evidence on effective non-pharmacological interventions to prevent the triad osteoporosis/falls risk/hip fracture. A scoping review was conducted consulting the Scientific Electronic Library Online (Scielo), National Institute for Health and Care Excellence (NICE), Cumulative Index to Nursing & Allied Health Literature (CINAHL) y PubMed.databases. Inclusion criteria were articles published between 2013 and 2019, in Spanish or English. In addition, publications on a population over 65 years of age covering non-pharmacological interventions aimed at hip fracture prevention for both institutionalised patients in long-stay health centres or hospitals, and patients cared for at home, both dependent and non-dependent, were included. Sixty-six articles were selected and 13 non-pharmacological interventions were identified according to the Nursing Interventions Classification taxonomy, aimed at preventing osteoporosis, falls, and hip fracture. The figures regarding the affected population according to the studies are alarming, reflecting the importance of preventing the triad osteoporosis, falls risk, and hip fracture among the population over 65 years of age. The most effective interventions were focused on increasing Bone Mineral Density through diet, exercise, and falls prevention. As a conclusion, primary prevention should be applied to the entire adult population, with special emphasis on people with osteoporosis.
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Requena G, Douglas IJ, Huerta C, de Abajo F. Impact of pre-exposure time bias in self-controlled case series when the event conditions the exposure: Hip/femur fracture and use of benzodiazepines as a case study. Pharmacoepidemiol Drug Saf 2020; 29:388-395. [PMID: 31923351 DOI: 10.1002/pds.4959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND In self-controlled case series (SCCS), the event should not condition the probability of subsequent exposure. If this assumption is not met, an important bias could take place. The association of hip/femur fracture (HFF) and use of benzodiazepines (BDZ) has a bidirectional causal relationship and can serve as case study to investigate the impact of this methodological issue. OBJECTIVES To assess the magnitude of bias introduced in a SCCS when HFF conditions the posterior exposure to BDZ and explore ways to correct it. METHODS Four thousand four hundred fifty cases of HFF who had at least one BZD prescription were selected from the primary care health record database BIFAP. Exposure to BZD was divided into non-use, current, recent, and past use. Conditional Poisson regression was used to estimate incidence rate ratios (IRRs) of HFF among current vs non-use/past, adjusted for age. To investigate possible event-exposure dependence, a pre-exposure time of different lengths (15, 30, and 60 days) was excluded from the reference category to evaluate the IRR. RESULTS IRR of HHF for current use was 0.79 (0.72-0.86); removing 30 days, IRR was 1.43 (1.31-1.57). Removing 15 days, IRR was 1.29 (1.18-1.41), and removing 60 days, IRR was 1.56 (1.42-1.72). A pre-exposure period up to 182 days was necessary to remove such effect giving an IRR of 1.64 (1.48-1.81). CONCLUSIONS HFF remarkably conditioned the use of BDZs resulting in seriously biased IRRs when this association was studied through a SCCS design. The use of pre-exposure periods of different lengths helped to correct this error.
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Affiliation(s)
- Gema Requena
- Department of Biomedical Sciences (Pharmacology), School of Medicine, University of Alcalá (IRYCIS), Madrid, Spain
| | - Ian J Douglas
- Epidemiology Deparment, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Consuelo Huerta
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Francisco de Abajo
- Department of Biomedical Sciences (Pharmacology), School of Medicine, University of Alcalá (IRYCIS), Madrid, Spain.,Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain
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Takeuchi Y, Shinozaki T, Matsuyama Y. A comparison of estimators from self-controlled case series, case-crossover design, and sequence symmetry analysis for pharmacoepidemiological studies. BMC Med Res Methodol 2018; 18:4. [PMID: 29310575 PMCID: PMC5759844 DOI: 10.1186/s12874-017-0457-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022] Open
Abstract
Background Despite the frequent use of self-controlled methods in pharmacoepidemiological studies, the factors that may bias the estimates from these methods have not been adequately compared in real-world settings. Here, we comparatively examined the impact of a time-varying confounder and its interactions with time-invariant confounders, time trends in exposures and events, restrictions, and misspecification of risk period durations on the estimators from three self-controlled methods. This study analyzed self-controlled case series (SCCS), case-crossover (CCO) design, and sequence symmetry analysis (SSA) using simulated and actual electronic medical records datasets. Methods We evaluated the performance of the three self-controlled methods in simulated cohorts for the following scenarios: 1) time-invariant confounding with interactions between the confounders, 2) time-invariant and time-varying confounding without interactions, 3) time-invariant and time-varying confounding with interactions among the confounders, 4) time trends in exposures and events, 5) restricted follow-up time based on event occurrence, and 6) patient restriction based on event history. The sensitivity of the estimators to misspecified risk period durations was also evaluated. As a case study, we applied these methods to evaluate the risk of macrolides on liver injury using electronic medical records. Results In the simulation analysis, time-varying confounding produced bias in the SCCS and CCO design estimates, which aggravated in the presence of interactions between the time-invariant and time-varying confounders. The SCCS estimates were biased by time trends in both exposures and events. Erroneously short risk periods introduced bias to the CCO design estimate, whereas erroneously long risk periods introduced bias to the estimates of all three methods. Restricting the follow-up time led to severe bias in the SSA estimates. The SCCS estimates were sensitive to patient restriction. The case study showed that although macrolide use was significantly associated with increased liver injury occurrence in all methods, the value of the estimates varied. Conclusions The estimations of the three self-controlled methods depended on various underlying assumptions, and the violation of these assumptions may cause non-negligible bias in the resulting estimates. Pharmacoepidemiologists should select the appropriate self-controlled method based on how well the relevant key assumptions are satisfied with respect to the available data. Electronic supplementary material The online version of this article (10.1186/s12874-017-0457-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. .,Department of Healthcare Information Management, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
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Takeuchi Y, Ando T, Ishiguro C, Uyama Y. Risk of Acute Asthma Attacks Associated With Nonsteroidal Anti-inflammatory Drugs: A Self-Controlled Case Series. Ther Innov Regul Sci 2016; 51:332-341. [PMID: 30231709 DOI: 10.1177/2168479016679865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although asthma attacks are known adverse events associated with nonsteroidal anti-inflammatory drug (NSAID) use, few studies have quantified these risks. The objectives of this study were to utilize an epidemiological approach to quantitatively evaluate the risk of acute asthma attacks associated with NSAID prescription in Japan and to compare the risks among NSAIDs according to their cyclooxygenase (COX)-2 selectivity. METHODS We conducted a self-controlled case series study using Japanese health insurance claims data. Exposed cases were identified as those who had experienced both NSAID prescription and acute asthma attack, which was defined as the combination of an inhalation procedure and the prescription of any inhaled β2-agonist. The incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for NSAID prescription periods compared with baseline periods were calculated using conditional Poisson regression models; COX-2 selective and nonselective NSAIDs were similarly compared. RESULTS We identified 9769 subjects, more than 95% of whom were younger than 60 years. There was a significantly higher risk of acute asthma attacks during the NSAID prescription period when compared with the baseline period. The quantified IRRs were, in descending order, 93.94 (95% CI, 90.10-97.95) for the prescription start date, 3.96 (95% CI, 3.63-4.33) for 1 to 9 days after the prescription start date, 3.01 (95% CI, 2.78-3.25) for 7 days after the prescription end date, 2.19 (95% CI, 1.82-2.65) for >9 days after the prescription start date, and 1.44 (95% CI, 1.29 -1.61) for 7 days before the prescription start date. There were lower asthmatic risks for COX-2 selective NSAIDs compared with nonselective NSAIDs. CONCLUSIONS The use of NSAIDs in Japan was associated with an increased risk of acute asthma attacks. However, this risk was lower in COX-2 selective NSAIDs.
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Affiliation(s)
- Yoshinori Takeuchi
- 1 Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Takashi Ando
- 1 Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Chieko Ishiguro
- 1 Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Yoshiaki Uyama
- 1 Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
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Lai CL, Kuo RNC, Chen HM, Chen MF, Chan KA, Lai MS. Risk of ischemic stroke during the initiation period of α-blocker therapy among older men. CMAJ 2015; 188:255-260. [PMID: 26644502 DOI: 10.1503/cmaj.150624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Alpha-blockers are notorious for their first-dose effect of acute hypotension during the early initiation period. Because acute cerebral hypoperfusion may precipitate an episode of ischemic stroke, we aimed to provide a quantitative estimate of the risk of ischemic stroke during the early initiation period of α-blocker therapy, using a self-controlled case series design. METHODS We identified all men aged 50 years or more as of 2007 who were incident users of α-blockers and had a diagnosis of ischemic stroke during the 2007-2009 study period using claims data from Taiwan's National Health Insurance claims database. The first day on which the α-blocker was prescribed was the index date. We partitioned different risk periods according to their relationship to the index date (pre-exposure risk periods 1 and 2 = ≤ 21 d and 22-60 d before index date, respectively; post-exposure risk periods 1 and 2 = ≤ 21 d and 22-60 d after index date, respectively); the remainder of the study period was defined as the unexposed period. We estimated the incidence rate ratio (IRR) of ischemic stroke in each risk period relative to the unexposed period using a conditional Poisson regression model. RESULTS A total of 7502 men were included. Compared with the risk in the unexposed period, the risk of ischemic stroke was increased in post-exposure risk period 1 among all patients in the study population (adjusted IRR 1.40, 95% confidence interval [CI], 1.22-1.61) and among patients without concomitant prescriptions for other antihypertensive agents (adjusted IRR 2.11, 95% CI 1.73-2.57). INTERPRETATION Alpha-blocker therapy was associated with an increased risk of ischemic stroke during the early initiation period, especially among patients who were not taking other antihypertensive agents.
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Affiliation(s)
- Chao-Lun Lai
- Department of Internal Medicine and Center for Critical Care Medicine (C.-L. Lai), National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Internal Medicine (C.-L. Lai), National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine (C.-L. Lai, M.-S. Lai) and Institute of Health Policy and Management (Kuo), College of Public Health, National Taiwan University, Taipei, Taiwan; Center for Comparative Effectiveness Research (Kuo, H.-M. Chen, M.-S. Lai), National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan; Departments of Internal Medicine (M.-F. Chen) and Medical Research (Chan), National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology (Chan), National Taiwan University College of Medicine, Taipei, Taiwan
| | - Raymond Nien-Chen Kuo
- Department of Internal Medicine and Center for Critical Care Medicine (C.-L. Lai), National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Internal Medicine (C.-L. Lai), National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine (C.-L. Lai, M.-S. Lai) and Institute of Health Policy and Management (Kuo), College of Public Health, National Taiwan University, Taipei, Taiwan; Center for Comparative Effectiveness Research (Kuo, H.-M. Chen, M.-S. Lai), National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan; Departments of Internal Medicine (M.-F. Chen) and Medical Research (Chan), National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology (Chan), National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ho-Min Chen
- Department of Internal Medicine and Center for Critical Care Medicine (C.-L. Lai), National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Internal Medicine (C.-L. Lai), National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine (C.-L. Lai, M.-S. Lai) and Institute of Health Policy and Management (Kuo), College of Public Health, National Taiwan University, Taipei, Taiwan; Center for Comparative Effectiveness Research (Kuo, H.-M. Chen, M.-S. Lai), National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan; Departments of Internal Medicine (M.-F. Chen) and Medical Research (Chan), National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology (Chan), National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Fong Chen
- Department of Internal Medicine and Center for Critical Care Medicine (C.-L. Lai), National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Internal Medicine (C.-L. Lai), National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine (C.-L. Lai, M.-S. Lai) and Institute of Health Policy and Management (Kuo), College of Public Health, National Taiwan University, Taipei, Taiwan; Center for Comparative Effectiveness Research (Kuo, H.-M. Chen, M.-S. Lai), National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan; Departments of Internal Medicine (M.-F. Chen) and Medical Research (Chan), National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology (Chan), National Taiwan University College of Medicine, Taipei, Taiwan
| | - K Arnold Chan
- Department of Internal Medicine and Center for Critical Care Medicine (C.-L. Lai), National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Internal Medicine (C.-L. Lai), National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine (C.-L. Lai, M.-S. Lai) and Institute of Health Policy and Management (Kuo), College of Public Health, National Taiwan University, Taipei, Taiwan; Center for Comparative Effectiveness Research (Kuo, H.-M. Chen, M.-S. Lai), National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan; Departments of Internal Medicine (M.-F. Chen) and Medical Research (Chan), National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology (Chan), National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mei-Shu Lai
- Department of Internal Medicine and Center for Critical Care Medicine (C.-L. Lai), National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Internal Medicine (C.-L. Lai), National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine (C.-L. Lai, M.-S. Lai) and Institute of Health Policy and Management (Kuo), College of Public Health, National Taiwan University, Taipei, Taiwan; Center for Comparative Effectiveness Research (Kuo, H.-M. Chen, M.-S. Lai), National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan; Departments of Internal Medicine (M.-F. Chen) and Medical Research (Chan), National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology (Chan), National Taiwan University College of Medicine, Taipei, Taiwan
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