Tamoxifen use correlates with increased risk of hip fractures in older women with breast cancer: A case-control study in Taiwan

Outcomes and Risks Associated With Subsequent Contralateral Hip Fractures

BACKGROUND

Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and social hardships that are compounded by a second hip fracture. With the aging US population and increasing rates of hip fractures, it is essential to understand factors surrounding subsequent contralateral hip fractures.

MATERIALS AND METHODS

This descriptive study was a retrospective review of patients 60 years and older who were identified in the institutional geriatric hip fracture database as having had an initial and subsequent contralateral hip fracture, with the second treated at our tertiary referral center.

RESULTS

The incidence of subsequent hip fracture was 13.2%. The mean time to second hip fracture was 3.5 years after the initial injury. The first fracture tended to be a femoral neck fracture, whereas the second injury was more likely to have an intertrochanteric pattern. There was a higher complication rate after a subsequent hip fracture. Patients taking osteoporosis and adjuvant medication prior to admission for the second fracture tended to have a lower 90-day mortality rate. Patients with a history of any fracture prior to the first hip fracture, with cancer, and with osteopenia had shorter intervals to the subsequent event.

CONCLUSION

Subsequent hip fractures carry high morbidity and mortality rates. Steps should be taken after the initial injury to optimize outcomes in the case of a subsequent event. Patients discharged after initial hip fracture should be maintained with osteoporosis medication. [Orthopedics. 2024;47(5):264-269.].

Risk of herpes zoster among patients with predialysis chronic kidney disease in a cohort study in Taiwan

BACKGROUND/OBJECTIVE

Patients on chronic dialysis are at risk of developing herpes zoster, but little systematic research focuses on the association between predialysis chronic kidney disease and herpes zoster. The objective of the study was to explore the association between predialysis chronic kidney disease and herpes zoster in Taiwan.

METHODS

A nation-based retrospective cohort study was performed using the 2005-2012 database of the Taiwan National Health Insurance Program. There were 16 655 subjects aged 20-84 years with newly diagnosed predialysis chronic kidney disease as the study group and 33 310 randomly selected subjects without chronic kidney disease as the comparison group. Both groups were matched with sex, age, comorbidities and the year of the index date. The incidence rates of herpes zoster in both groups were calculated. The multivariable Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for herpes zoster associated with predialysis chronic kidney disease.

RESULTS

The overall incidence rate of herpes zoster was 1.4-fold higher in the predialysis chronic kidney disease group than that in the non-chronic kidney disease group (8.76 vs 6.27 per 1000 person-years, 95% CI 1.27-1.54; P < .001). After controlling for co-variables, the adjusted HR of herpes zoster was 1.38 (95% CI 1.25-1.53; P < .001) for subjects with predialysis chronic kidney disease compared with non-chronic kidney disease subjects. The adjusted HR increased to 1.65 for subjects with predialysis chronic kidney disease and with any comorbidity (95% CI 1.42-1.92; P < .001).

CONCLUSIONS

Patients with predialysis chronic kidney disease correlate with approximately 1.4-fold increased hazard of developing herpes zoster.

Association between Parkinson's disease and proton pump inhibitors therapy in older people

OBJECTIVES

The study was to explore the association between Parkinson's disease and proton pump inhibitors use.

METHODS

A population-based case-control study was conducted to analyze the 2000-2013 database of Taiwan National Health Insurance Program. In total, there were 4280 participants aged ≥65 years with newly diagnosed Parkinson's disease as the case group and 4280 sex- and age-matched participants without Parkinson's disease as the control group. Ever use of proton pump inhibitors was defined as participants who had at least a prescription for proton pump inhibitors before the index date. Never use of proton pump inhibitors was defined as participants who did not have a prescription for proton pump inhibitors before the index date. The odds ratio and 95% confidence interval were used to estimate the association between Parkinson's disease and proton pump inhibitors use by the logistic regression model.

RESULTS

A significant association was detected between Parkinson's disease and proton pump inhibitors use (odds ratio 1.15, 95% confidence interval 1.04-1.27).

CONCLUSIONS

An association is found between Parkinson's disease and proton pump inhibitors use in older people. Other real-world data are required to confirm the clinical impact of proton pump inhibitors therapy on the risk of Parkinson's disease.

Association of hepatocellular carcinoma with thiazolidinediones use: A population-based case-control study

The study aimed to investigate the association between the risk of hepatocellular carcinoma and thiazolidinediones use among type 2 diabetic patients who had risk factors for hepatocellular carcinoma.A population-based case-control study was performed using the database of the Taiwan National Health Insurance Program. The cases consisted of 23580 type 2 diabetic subjects aged 20 to 84 years with newly diagnosed hepatocellular carcinoma between 2000 and 2011. The sex- and age-matched controls consisted of 23580 randomly selected type 2 diabetic subjects without hepatocellular carcinoma between 2000 and 2011. Ever use of thiazolidinediones was defined as subjects who had at least 1 prescription of thiazolidinediones before the index date. Never use of thiazolidinediones was defined as subjects who did not have a prescription of thiazolidinediones before the index date. The odds ratio and 95% confidence interval for the association between hepatocellular carcinoma and cumulative duration of thiazolidinediones use was measured by a multivariable logistic regression model.Among subjects with any 1 of the comorbidities including alcohol-related disease, cirrhosis, hepatitis B infection, hepatitis C infection, and other chronic hepatitis, a multivariable logistic regression model demonstrated that there was a negative association between hepatocellular carcinoma and every 1-year increase of cumulative duration of thiazolidinediones use (adjusted odds ratio 0.94, 95% confidence interval 0.92-0.97).There was a negative association in a duration-dependent manner between the risk of hepatocellular carcinoma and thiazolidinediones use among type 2 diabetic patients who had risk factors for hepatocellular carcinoma.

Evaluating the association between avascular necrosis of femoral head and oral corticosteroids use in Taiwan

The aim of this study was to assess a correlation between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. A population-based case-control study was performed to analyze the database of Taiwan National Health Insurance Program. The study consisted of 3002 subjects aged 20 to 84 with newly diagnosed avascular necrosis of femoral head between 2000 and 2013 as the cases and 11279 sex-matched and age-matched subjects without avascular necrosis of femoral head as the matched controls. Use of oral corticosteroids was defined as subjects who had at least a prescription for oral corticosteroids before the index date. No use of oral corticosteroids was defined as subjects who did not have a prescription for oral corticosteroids before the index date. The logistic regression model revealed that subjects with avascular necrosis of femoral head were 1.65 times more likely to be exposed to oral corticosteroids than those subjects without avascular necrosis of femoral head (OR 1.65, 95% CI = 1.51-1.80). A sub-analysis revealed that there was a significant association between avascular necrosis of femoral head and increasing cumulative duration of oral corticosteroids for each additional month of use (OR 1.03, 95% CI = 1.02-1.03). A significant association is detected between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. There is a duration-dependent effect of oral corticosteroids use on the risk of avascular necrosis of femoral head. Clinicians should be aware of the risk of avascular necrosis of femoral head when oral corticosteroids are prescribed for a long time.

Prediction of Recurrence-associated Death from Localized Prostate Cancer with a Charlson Comorbidity Index-reinforced Machine Learning Model

Research has failed to resolve the dilemma experienced by localized prostate cancer patients who must choose between radical prostatectomy (RP) and external beam radiotherapy (RT). Because the Charlson Comorbidity Index (CCI) is a measurable factor that affects survival events, this research seeks to validate the potential of the CCI to improve the accuracy of various prediction models. Thus, we employed the Cox proportional hazard model and machine learning methods, including random forest (RF) and support vector machine (SVM), to model the data of medical records in the National Health Insurance Research Database (NHIRD). In total, 8581 individuals were enrolled, of whom 4879 had received RP and 3702 had received RT. Patients in the RT group were older and exhibited higher CCI scores and higher incidences of some CCI items. Moderate-to-severe liver disease, dementia, congestive heart failure, chronic pulmonary disease, and cerebrovascular disease all increase the risk of overall death in the Cox hazard model. The CCI-reinforced SVM and RF models are 85.18% and 81.76% accurate, respectively, whereas the SVM and RF models without the use of the CCI are relatively less accurate, at 75.81% and 74.83%, respectively. Therefore, CCI and some of its items are useful predictors of overall and prostate-cancer-specific survival and could constitute valuable features for machine-learning modeling.