| アブストラクト | BACKGROUND: Patients with rheumatoid arthritis (RA) commonly use oral glucocorticoids (GCs) and proton pump inhibitors (PPIs), both associated with osteoporotic fractures. We investigated the association between concomitant use of oral GCs and PPIs and the risk of osteoporotic fractures among patients with RA. METHODS: This was a cohort study including patients with RA aged 50+ years from the Clinical Practice Research Datalink between 1997 and 2017. Exposure to oral GCs and PPIs was stratified by the most recent prescription as current use (<6 months), recent use (7-12 months) and past use (>1 year); average daily and cumulative dose; and duration of use. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus, forearm, pelvis and ribs) was estimated by time-dependent Cox proportional-hazards models, statistically adjusted for lifestyle parameters, comorbidities and comedications. RESULTS: Among 12 351 patients with RA (mean age of 68 years, 69% women), 1411 osteoporotic fractures occurred. Concomitant current use of oral GCs and PPIs was associated with a 1.6-fold increased risk of osteoporotic fractures compared with non-use (adjusted HR: 1.60, 95% CI: 1.35 to 1.89). This was statistically different from a 1.2-fold increased osteoporotic fracture risk associated with oral GC or PPI use alone. Most individual fracture sites were significantly associated with concomitant use of oral GCs and PPIs. Among concomitant users, fracture risk did not increase with higher daily dose or duration of PPI use. CONCLUSIONS: There was an interaction in the risk of osteoporotic fractures with concomitant use of oral GCs and PPIs. Fracture risk assessment could be considered when a patient with RA is co-prescribed oral GCs and PPIs. |
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| 投稿者 | Abtahi, Shahab; Driessen, Johanna H M; Burden, Andrea M; Souverein, Patrick C; van den Bergh, Joop P; van Staa, Tjeerd P; Boonen, Annelies; de Vries, Frank |
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| 組織名 | Department of Clinical Pharmacy and Toxicology, Maastricht University Medical;Centre, Maastricht, The Netherlands.;Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for;Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.;Cardiovascular Research Institute Maastricht (CARIM), Maastricht University,;Maastricht, The Netherlands.;NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht;University Medical Centre, Maastricht, The Netherlands.;Institute of Pharmaceutical Sciences, Department of Chemistry and Applied;Biosciences, ETH-Zurich, Zurich, Switzerland.;Department of Internal Medicine, Division of Rheumatology, Maastricht University;Medical Centre, Maastricht, The Netherlands.;Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.;Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands.;Centre for Health Informatics, Division of Informatics, Imaging and Data Science,;School of Health Sciences, Faculty of Biology, Medicine and Health, The;University of Manchester, Manchester, UK.;Care and Public Health Research Institute (CAPHRI), Maastricht University,;Centre, Maastricht, The Netherlands f.devries@uu.nl.;MRC Epidemiology Lifecourse Unit, Southampton General Hospital, Southampton, UK. |
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