| アブストラクト | PURPOSE: To evaluate the effects of different definitions of glucocorticoid (GC) exposure on the magnitude and pattern of fracture risk using the same dataset. METHODS: Data from patients with rheumatoid arthritis (RA) were extracted from the Clinical Practice Research Datalink, a primary care database with electronic health records in the United Kingdom. Patients exposed to oral GCs were matched to up to two unexposed patients by age, gender and location. The first osteoporotic fracture was identified and adjusted and unadjusted cox proportional hazard ratios (HR) and 95% confidence intervals (CI) produced for fracture risk following GC therapy using different models of risk attribution. These include models demonstrating the effect of dose, duration and recency of GC exposure. RESULTS: There were 16,507 patients included. Exposed patients were older and had more comorbidities. GC therapy was associated with an increased risk of fracture, with the effect size influenced by risk attribution model. The risk of fracture decreased with less recent exposure from HR (95% CI) 1.66 (1.27, 2.16) during the first month of stopping GCs to 1.11 (0.79, 1.57) for between 1 and 3months. The risk of fracture increased with current daily dose, HR 1.44 (1.17, 1.77) for 5-9.9mg prednisolone equivalent dose (PEQ) to 3.02 (1.77, 5.15) for 15-19.9mg PEQ. Risk of fracture increased with cumulative dose, a function of dose and duration, from HR 1.22 (1.03, 1.44) for <1g to 1.83 (1.35, 2.48) for 7.5-10g. CONCLUSION: GC exposure was associated with excess fracture risk, with effect size differing according to definition of exposure. This highlights the need to incorporate all exposure dimensions (dose, duration and recency) in these patient's fracture risk assessments. |
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| 組織名 | Arthritis Research UK Centre for Epidemiology, School of Biological Sciences,;Faculty of Biology, Medicine and Health, The University of Manchester, Oxford;Road, Manchester M13 9PT, UK.;Health eResearch Centre, Farr Institute for Health Informatics Research,;University of Manchester, Vaughan House, Portsmouth Road, M13 9PL, UK; Utrecht;University, Faculty of Science, Division of Pharmacoepidemiology and Clinical;Pharmacology, Utrecht, the Netherlands.;MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General;Hospital, Tremona Road, Southampton SO16 6YD, UK; Victoria University,;Wellington, New Zealand.;Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Biomedical;Research Unit, Nuffield Department of Orthopaedics, Rheumatology and;Musculoskeletal Sciences, University of Oxford, Oxford OX3 5UG, UK; NIHR;Nutrition Biomedical Research Centre, University of Southampton and University;Hospital Southampton NHS Foundation Trust, Southampton General Hospital,;Southampton SO16 6YD, UK.;Road, Manchester M13 9PT, UK; Health eResearch Centre, Farr Institute for Health;Informatics Research, University of Manchester, Vaughan House, Portsmouth Road,;M13 9PL, UK; NIHR Manchester Biomedical Research Centre, Manchester University,;NHS Foundation Trust, Manchester Academic Health Science Centre, UK. Electronic;address: will.dixon@manchester.ac.uk. |
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