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Retrospective claims analysis indicated that high levels of daily and cumulative doses of systemic glucocorticoids were associated with elevated fracture risk in a large cohort of new RA patients under age 65.
Rheumatoid
arthritis is an inflammatory ill condition marked by destruction of
periarticular bone and joint structures and also has been associated with
osteoporosis. This article shows that the risk of fractures is directly
proportional to the dose given in patients who have newly detected rheumatoid
arthritis.
Retrospective
claims analysis indicated that high levels of daily and cumulative doses of
systemic glucocorticoids were associated with elevated fracture risk in a large
cohort of new RA patients under age 65. Heightened risk began to decline within
months of discontinuation. Findings were similar among patients age <50
years. We evaluated the impact of systemic glucocorticoid exposure on fracture
risk among relatively young patients with new-onset rheumatoid arthritis (RA).
Using
administrative data, we identified 42,127 RA patients diagnosed January 1,
2005–December 31, 2012, age 18–64 years, with benefits coverage for ≥12 months
before RA diagnosis. Follow-up extended to clinical fracture, cancer diagnosis,
or December 31, 2012. Glucocorticoid users were new to therapy. Fracture
incidence rates (IR) were stratified by glucocorticoid exposure expressed as
prednisone equivalent doses. Cox’s proportional hazards models estimated
fracture risk adjusted for demographics and baseline clinical characteristics
to assess dose-response relationships with current (daily) and prior (cumulative)
dose, and by time since discontinuation.
Most patients (85
%) had glucocorticoid exposure. Exposed and unexposed patients were
demographically similar (74 % female; mean age 49.7 and 48.8 years); 1 % had
prior fracture. Fracture IRs (95 % confidence intervals) were 5 to 9 per 1000
person-years at doses <15 mg/day, 16.0 (11.0, 22.6) at doses ≥15 mg/day, and
13.4 (10.7, 16.7) at highest dose levels compared with 0 mg/day current daily
dose and <675 mg cumulative dose, respectively. Fracture risk was 29 % lower
at 60–182 days’ post-discontinuation compared with ongoing use and was similar
to unexposed patients by 12 months. Findings were similar among patients age
<50 years.
Among younger,
new-onset RA patients, fracture risk was significantly elevated at high levels
of daily and cumulative dose, and was similar to unexposed patients by 12 months’
post-discontinuation.
Osteoporosis international
Glucocorticoid exposure and fracture risk in patients with new-onset rheumatoid arthritis
A. Balasubramanian et al.
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