Low Bone Mineral Density and Calcium Levels as Risks for Mortality in Patients with Self-Discontinuation of Anti-Osteoporosis Medication
Abstract
:1. Introduction
2. Materials and Methods
2.1. Enrolled Participants
2.2. Study Design
2.3. Fracture Identification
2.4. BMD Measurements
2.5. Statistical Analysis
3. Results
3.1. Demographic Data and Concomitant Medication by BMD
3.2. Comparisons between Survivors and Non-Survivors
3.3. Predictive Factors for Mortality in Patients with Prior Exposure to Anti-Osteoporosis Medication That Was Later Discontinued
3.4. Survival Analysis of Participants by BMD and Gender
3.5. Causes of Mortality
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Group A Lumbar Spine ≥ 0.715 g/cm2 and Right Femoral Neck ≥ 0.550 g/cm2 | Group B Lumbar Spine < 0.715 g/cm2 and Right Femoral Neck ≥ 0.550 g/cm2 | Group C Lumbar Spine ≥ 0.715 g/cm2 and Right Femoral Neck < 0.550 g/cm2 | Group D Lumbar Spine < 0.715 g/cm2 and Right Femoral Neck < 0.550 g/cm2 | p Value |
---|---|---|---|---|---|
n = 291 | n = 108 | n = 107 | n = 90 | ||
Age (years) | 73.9 ± 10.3 | 78.6 ± 9.0 | 81.5 ± 10.2 | 81.7 ± 8.4 | <0.001 #,¤,à |
Gender-Female | 230 (79.0%) | 85 (78.7%) | 83 (77.6%) | 78 (86.7%) | 0.368 |
Body height (cm) | 155.2 ± 7.2 | 154.8 ± 7.4 | 154.7 ± 7.9 | 151.4 ± 8.9 | 0.003 à,ê,¢ |
Body weight (kg) | 57.7 ± 9.5 | 57.2 ± 11.7 | 54.3 ± 9.5 | 49.5 ± 10.9 | <0.001 ¤,à,ê,¢ |
BMI (kg/m2) | 24.0 ± 3.8 | 24.0 ± 4.4 | 22.7 ± 3.7 | 21.5 ± 4.1 | <0.001 #,¤,ê |
Smoking | 27 (9.4%) | 11 (10.2%) | 14 (13.3%) | 9 (10.0%) | 0.730 |
Alcohol consumption | 16 (8.7%) | 3 (4.0%) | 5 (5.8%) | 5 (7.4%) | 0.539 |
Calcium supplement | 180 (61.9%) | 74 (68.5%) | 79 (73.8%) | 55 (61.1%) | 0.106 |
Vitamin D supplement | 55 (18.9%) | 26 (24.1%) | 29 (27.1%) | 20 (22.2%) | 0.316 |
Raloxifene | 92 (31.6%) | 32 (29.6%) | 30 (28.0%) | 34 (37.8%) | 0.491 |
Alendronate | 87 (29.9%) | 25 (23.2%) | 28 (26.2%) | 26 (28.9%) | 0.574 |
Zoledronic acid | 23 (7.9%) | 14 (13.0%) | 12 (11.2%) | 4 (4.4%) | 0.140 |
Denosumab | 123 (42.3%) | 62 (57.4%) | 58 (54.2%) | 44 (48.9%) | 0.025 # |
Teriparatide | 31 (10.7%) | 19 (17.6%) | 24 (22.4%) | 35 (38.9%) | <0.001 ¤,à,ê,¢ |
Laboratory test | |||||
25(OH)D3 (ng/mL) | 31.3 ± 13.4 | 25.0 ±6.1 | 15.1 ± 9.3 | 14.8 ± 10.2 | 0.036 |
Calcium (mg/dL) | 8.8 ± 1.0 | 8.6 ±1.3 | 8.6 ± 1.1 | 8.4 ± 1.5 | 0.021¤ |
Phosphorus (mg/dL) | 3.5 ± 1.2 | 3.4 ±1.0 | 3.4 ± 1.2 | 3.5 ± 1.3 | 0.932 |
Creatinine (mg/dL) | 1.0 ±0.8 | 0.9 ± 0.3 | 1.3 ± 1.2 | 1.3 ± 1.7 | 0.179 |
Intact-PTH (pg/dL) | 144.2 ±167.7 | 83.4 ± 81.6 | 276.5 ± 372.9 | 389.8 ± 591.1 | 0.108 |
Comorbidity | |||||
Osteoarthritis | 201 (69.1%) | 80 (74.1%) | 78 (72.9%) | 50 (55.6%) | 0.023 à,ê,¢ |
Rheumatoid arthritis | 19 (6.5%) | 13 (12.0%) | 10 (9.4%) | 5 (5.6%) | 0.232 |
Diabetes mellitus | 76 (26.1%) | 33 (30.6%) | 45 (42.1%) | 19 (21.1%) | 0.005 ¤,¢ |
Hypertension | 146 (50.2%) | 62 (57.4%) | 75 (70.1%) | 59 (65.6%) | 0.001 ¤,à |
Stroke | 41 (14.1%) | 19 (17.6%) | 29 (27.1%) | 27 (30.0%) | 0.001 ¤ |
Cataract | 85 (29.2%) | 31 (28.7%) | 31 (29.0%) | 23 (25.6%) | 0.926 |
Hyperthyroidism | 22 (7.6%) | 10 (9.3%) | 11 (10.3%) | 3 (3.3%) | 0.286 |
Chronic liver disease | 61 (21.0%) | 19 (17.6%) | 28 (26.2%) | 14 (15.6%) | 0.255 |
Variables | Survival (n = 386) | Mortality (n = 210) | p Value |
---|---|---|---|
Number of fractures | <0.001 | ||
0 | 65 (16.8%) | 15 (7.1%) | |
1 | 265 (68.7%) | 135 (64.3%) | |
≥2 | 56 (14.5%) | 60 (28.6%) | |
Age (years) | 74.4 ± 10.1 | 82.7 ± 8.5 | <0.001 |
Gender-Female | 333 (86.3%) | 143 (68.1%) | <0.001 |
Body height (cm) | 154.5 ± 7.3 | 154.6 ± 8.4 | 0.844 |
Body weight (kg) | 56.6 ± 10.3 | 54.4 ± 10.9 | 0.009 |
BMI (kg/m2) | 23.8 ± 3.9 | 22.8 ± 4.2 | 0.005 |
Smoking | 39 (7.6%) | 32 (15.5%) | 0.006 |
Alcohol consumption | 15 (6.0%) | 14 (8.5%) | 0.428 |
Bone mineral density (g/cm2) | <0.001 | ||
A: Lumbar spine ≥ 0.715 and right femoral neck ≥ 0.550 | 224 (58.0%) | 67 (31.9%) | |
B: Lumbar spine < 0.715 and right femoral neck ≥ 0.550 | 69 (17.9%) | 39 (18.6%) | |
C: Lumbar spine ≥ 0.715 and right femoral neck < 0.550 | 52 (13.5%) | 55 (26.2%) | |
D: Lumbar spine < 0.715 and right femoral neck < 0.550 | 41 (10.6%) | 49 (23.3%) | |
Calcium supplement | 242 (62.7%) | 146 (69.5%) | 0.114 |
Vitamin D supplement | 77 (20.0%) | 53 (25.2%) | 0.165 |
Raloxifene | 127 (32.9%) | 61 (29.1%) | 0.382 |
Alendronate | 105 (27.2%) | 61 (29.1%) | 0.701 |
Zoledronic acid | 40 (10.4%) | 13 (6.2%) | 0.119 |
Denosumab | 174 (45.1%) | 113 (53.8%) | 0.051 |
Teriparatide | 58 (15.0%) | 51 (24.3%) | 0.007 |
Comorbidity | |||
Osteoarthritis | 267 (69.2%) | 142 (67.6%) | 0.766 |
Rheumatoid arthritis | 33 (8.6%) | 14 (6.7%) | 0.512 |
Diabetes mellitus | 92 (23.8%) | 81 (38.6%) | <0.001 |
Hypertension | 189 (49.0%) | 153 (72.9%) | <0.001 |
Stroke | 61 (15.8%) | 55 (26.2%) | 0.003 |
Cataract | 106 (27.5%) | 64 (30.5%) | 0.494 |
Hyperthyroidism | 30 (7.7%) | 16 (7.6%) | 1.000 |
Chronic liver disease | 70 (18.1%) | 52 (24.8%) | 0.070 |
Variables | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
HR | 95% CI | p Value | HR | 95% CI | p Value | |
Gender (Male vs. Female) | 2.16 | (1.62–2.90) | <0.001 | 1.87 | (1.22–2.86) | 0.004 |
Age (years) | 1.06 | (1.05–1.08) | <0.001 | 1.02 | (1.00–1.04) | 0.078 |
Number of fractures | ||||||
0 | reference | reference | ||||
1 | 1.85 | (1.08–3.15) | 0.024 | 1.71 | (0.72–4.04) | 0.222 |
≥2 | 2.97 | (1.68–5.23) | <0.001 | 1.84 | (0.74–4.57) | 0.188 |
Bone mineral density (g/cm2) | ||||||
A: Lumbar spine ≥ 0.715 and right femoral neck ≥ 0.550 | reference | reference | ||||
B: Lumbar spine < 0.715 and right femoral neck ≥ 0.550 | 1.59 | (1.07–2.36) | 0.021 | 1.68 | (0.93–3.04) | 0.083 |
C: Lumbar spine ≥ 0.715 and right femoral neck < 0.550 | 2.60 | (1.82–3.72) | <0.001 | 1.90 | (1.13–3.14) | 0.016 |
D: Lumbar spine < 0.715 and right femoral neck < 0.550 | 3.08 | (2.13–4.45) | <0.001 | 3.09 | (1.84–5.21) | <0.001 |
p for trend <0.001 | <0.001 | |||||
Laboratory test | ||||||
Calcium (mg/dL) | 0.79 | (0.72–0.87) | <0.001 | 0.87 | (0.76–0.99) | 0.033 |
Creatinine (mg/dL) | 1.36 | (1.22–1.51) | <0.001 | 1.22 | (1.07–1.39) | 0.002 |
Comorbidity | ||||||
Diabetes mellitus | 1.72 | (1.29–2.25) | <0.001 | 1.44 | (0.98–2.11) | 0.063 |
Rheumatoid arthritis | 0.74 | (0.43–1.27) | 0.274 | 0.84 | (0.36–1.97) | 0.693 |
Hyperthyroidism | 0.96 | (0.57–1.59) | 0.861 | 1.58 | (0.78–3.22) | 0.207 |
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Hsu, C.-S.; Chang, S.-T.; Cheng, Y.-Y.; Lee, H.-T.; Chen, C.-H.; Deng, Y.-L.; Hsu, C.-Y.; Chen, Y.-M. Low Bone Mineral Density and Calcium Levels as Risks for Mortality in Patients with Self-Discontinuation of Anti-Osteoporosis Medication. Int. J. Environ. Res. Public Health 2022, 19, 197. https://doi.org/10.3390/ijerph19010197
Hsu C-S, Chang S-T, Cheng Y-Y, Lee H-T, Chen C-H, Deng Y-L, Hsu C-Y, Chen Y-M. Low Bone Mineral Density and Calcium Levels as Risks for Mortality in Patients with Self-Discontinuation of Anti-Osteoporosis Medication. International Journal of Environmental Research and Public Health. 2022; 19(1):197. https://doi.org/10.3390/ijerph19010197
Chicago/Turabian StyleHsu, Chun-Sheng, Shin-Tsu Chang, Yuan-Yang Cheng, Hsu-Tung Lee, Chih-Hui Chen, Ya-Lian Deng, Chiann-Yi Hsu, and Yi-Ming Chen. 2022. "Low Bone Mineral Density and Calcium Levels as Risks for Mortality in Patients with Self-Discontinuation of Anti-Osteoporosis Medication" International Journal of Environmental Research and Public Health 19, no. 1: 197. https://doi.org/10.3390/ijerph19010197