Glucocorticoids up risk of vertebral fractures in RA patients
The risk of vertebral fractures increases with longer duration and higher dose of oral glucocorticoids (GCs) in patients with rheumatoid arthritis (RA), but the dose and duration of GC do not contribute to the risk of hip and nonvertebral/nonhip fractures, reports a recent study.
The investigators observed 11,599 fracturs in 9,964 out of 138,240 patients with RA. Of these, 68.2 percent used oral GC for >3 months during follow-up.
Based on adjusted analysis, the risk of vertebral fractures was increased by duration of GC ≥6 months (odds ratio [OR], 1.76; p<0.01), mean dose of GC ≥2.5 mg (OR range, 1.37–1.71; p<0.01) and highest daily dose of GC ≥10 mg (OR range, 1.23–1.75; p<0.03). However, duration and dose of oral GC did not increase the risk of hip and nonvertebral/nonhip fractures in patients with RA.
Results were consistent in RA patients without osteoporosis.
To establish a retrospective cohort of patients with RA ≥19 years old, the investigators used the Korean National Healthcare Claims database from 2010. They followed these patients through December 2013 and calculated the incidence rates of total and major fractures.
Multivariable logistic regression analyses were used to evaluate the effects of GC dose and duration on fractures. The investigators also examined the influence of GC on fractures in RA patients without a history of osteoporosis.
In a 2004 study, researchers observed a dose dependence of fracture risk for hip, vertebral, nonvertebral and any fractures. Longer duration and continuous pattern of GC use showed a fivefold increased risk of hip fracture and nearly sixfold increased risk of vertebral fracture. Hip and vertebral fracture risks further increased by sevenfold and 17-fold, respectively, with the combined effect of higher dose, longer duration and continuous pattern of GC use. [Osteoporos Int 2004;15:323-328]