PPI, oral glucocorticoids use linked to fracture risk in rheumatoid arthritis patients: BMJ
Netherlands: Concomitant use of PPIs and oral glucocorticoids increases risk of osteoporotic fractures by 1.6-fold in rheumatoid arthritis (RA) patients (aged 50 years and above), finds a recent study. The results of the study, published in the BMJ journal Annals of the Rheumatic Diseases, suggests that fracture risk assessment should be considered when a RA patient is prescribed both oral GCs and PPIs.
Rheumatoid arthritis patients commonly use proton pump inhibitors (PPIs) and oral glucocorticoids (GCs) both of which are associated with osteoporotic fractures. Shahab Abtahi, Maastricht University Medical Centre, Maastricht, The Netherlands, and colleagues investigated the association between concomitant use of oral GCs and PPIs and osteoporotic fractures risk among RA patients.
For the purpose, the researchers conducted a cohort study that included patients with RA aged 50+ years from the Clinical Practice Research Datalink between 1997 and 2017. Exposure to PPIs and oral GCs was stratified by the most recent prescription as current use (<6 months), recent use (7–12 months) and past use (>1 year); duration of use; cumulative dose; and average daily. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus, forearm, pelvis and ribs) was then estimated using time-dependent Cox proportional-hazards models.
Among 12 351 patients with RA (mean age of 68 years, 69% women), 1411 osteoporotic fractures occurred.
Key findings of the study include:
- Concomitant current use of oral GCs and PPIs was associated with a 1.6-fold increased riskof osteoporotic fractures compared with non-use (adjusted HR: 1.60).
- This wasstatistically different from a 1.2-fold increased osteoporotic fracture riskassociated 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.
"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," wrote the authors.
The study titled, "Concomitant use of oral glucocorticoids and proton pump inhibitors and risk of osteoporotic fractures among patients with rheumatoid arthritis: a population-based cohort study," is published in the BMJ journal Annals of the Rheumatic Diseases.
DOI: https://ard.bmj.com/content/early/2021/02/21/annrheumdis-2020-218758
