Low-dose oral glucocorticoid therapy and risk of osteoporotic fractures in patients with rheumatoid arthritis: a cohort study using the Clinical Practice Research Datalink
Low-dose oral glucocorticoid therapy and risk of osteoporotic fractures in patients with rheumatoid arthritis: a cohort study using the Clinical Practice Research Datalink
OBJECTIVES: Clinical trials have shown that low-dose glucocorticoid therapy in patients with 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 and 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) was estimated by time-dependent Cox proportional-hazards models, adjusted for lifestyle 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 dose/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.
Aged, Arthritis, Rheumatoid/chemically induced, Cohort Studies, Female, Glucocorticoids/therapeutic use, Humans, Male, Osteoporotic Fractures/chemically induced, Risk Factors, Spinal Fractures/chemically induced
1448-1458
Abtahi, Shahab
67e77f66-1a07-40df-bf9b-4b2fb874d328
Driessen, Johanna H M
ca186d54-4f1c-4131-ba45-78357fe592dd
Burden, Andrea M
57cecd33-0b9a-4c2d-b3a6-dcbbe648dd75
Souverein, Patrick C
f03a0bb7-345e-4679-8368-495bd05df068
van den Bergh, Joop P
6e5c6e03-9e3c-4677-84fe-9f4855a91d9f
van Staa, Tjeerd P
76db275d-12ed-44e8-8dd1-2d70e945fc07
Boonen, Annelies
c32bd0a4-48b2-45f9-9ab3-5ff0074b7f32
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
14 July 2022
Abtahi, Shahab
67e77f66-1a07-40df-bf9b-4b2fb874d328
Driessen, Johanna H M
ca186d54-4f1c-4131-ba45-78357fe592dd
Burden, Andrea M
57cecd33-0b9a-4c2d-b3a6-dcbbe648dd75
Souverein, Patrick C
f03a0bb7-345e-4679-8368-495bd05df068
van den Bergh, Joop P
6e5c6e03-9e3c-4677-84fe-9f4855a91d9f
van Staa, Tjeerd P
76db275d-12ed-44e8-8dd1-2d70e945fc07
Boonen, Annelies
c32bd0a4-48b2-45f9-9ab3-5ff0074b7f32
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Abtahi, Shahab, Driessen, Johanna H M, Burden, Andrea M, Souverein, Patrick C, van den Bergh, Joop P, van Staa, Tjeerd P, Boonen, Annelies and de Vries, Frank
(2022)
Low-dose oral glucocorticoid therapy and risk of osteoporotic fractures in patients with rheumatoid arthritis: a cohort study using the Clinical Practice Research Datalink.
Rheumatology (Oxford, England), 61 (4), .
(doi:10.1093/rheumatology/keab548).
Abstract
OBJECTIVES: Clinical trials have shown that low-dose glucocorticoid therapy in patients with 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 and 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) was estimated by time-dependent Cox proportional-hazards models, adjusted for lifestyle 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 dose/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.
Text
keab548
- Version of Record
More information
Published date: 14 July 2022
Additional Information:
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Keywords:
Aged, Arthritis, Rheumatoid/chemically induced, Cohort Studies, Female, Glucocorticoids/therapeutic use, Humans, Male, Osteoporotic Fractures/chemically induced, Risk Factors, Spinal Fractures/chemically induced
Identifiers
Local EPrints ID: 476324
URI: http://eprints.soton.ac.uk/id/eprint/476324
ISSN: 1462-0324
PURE UUID: 9831e7c7-74f6-42a9-8254-de8507a42ccf
Catalogue record
Date deposited: 19 Apr 2023 16:40
Last modified: 17 Mar 2024 01:28
Export record
Altmetrics
Contributors
Author:
Shahab Abtahi
Author:
Johanna H M Driessen
Author:
Andrea M Burden
Author:
Patrick C Souverein
Author:
Joop P van den Bergh
Author:
Tjeerd P van Staa
Author:
Annelies Boonen
Author:
Frank de Vries
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics