OBJECTIVES: Clinical trials have shown that low-dose glucocorticoid therapy in patients with rheumatoid arthritis (RA) reduces bone loss in hands or hip, but the effect on osteoporotic fractures is not yet clear. Therefore, we investigated the use of low-dose oral glucocorticoids and 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 1997-2017. Exposure to oral glucocorticoids was stratified by the most recent prescription in current (<6 months), recent (7-12 months), and past (>1 year) use, and average daily and cumulative doses. Risk of incident osteoporotic fractures (including hip, vertebrae, humerus, forearm, pelvis, and ribs) were estimated by time-dependent Cox proportional-hazards models, adjusted for life-style parameters, comorbidities, and comedications. Secondary analyses assessed osteoporotic fracture risk with a combination of average daily and cumulative doses of oral glucocorticoids.
RESULTS: Among 15 123 patients with RA (mean age 68.8 years, 68% females), 1640 osteoporotic fractures occurred. Current low-dose oral glucocorticoid therapy (</=7.5 mg prednisolone equivalent/day) in patients with RA was not associated with overall risk of osteoporotic fractures (adjusted hazard ratio 1.14, 95% CI 0.98-1.33) compared with past glucocorticoid use, but was associated with an increased risk of clinical vertebral fracture (adjusted hazard ratio 1.59, 95% CI 1.11-2.29). Results remained unchanged regardless of a short-term or a long-term use of oral glucocorticoids.
CONCLUSION: Clinicians should be aware that even in RA patients who receive low daily glucocorticoid doses, the risk of clinical vertebral fracture is increased.
|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|
|組織名||Department of Clinical Pharmacy and Toxicology, Maastricht University Medical;Centre, Maastricht, the Netherlands.;Cardiovascular Research Institute Maastricht (CARIM), Maastricht University,;Maastricht, the Netherlands.;Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for;Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.;NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht;University Medical Center, 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.;Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands.;Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.;Centre for Health Informatics, Division of Informatics, Imaging and Data Science,;School of Health Sciences, Faculty of Biology, Medicine and Health, University of;Manchester, Manchester Academic Health Science Centre, Manchester, United;Kingdom.;Care and Public Health Research Institute (CAPHRI), Maastricht University,;MRC Epidemiology Lifecourse Unit, Southampton General Hospital, Southampton,;United Kingdom.|