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03-08-2021 | Rheumatoid arthritis | News

RA vertebral fracture risk increased with low-dose glucocorticoids

Author: Hannah Kitt


medwireNews: In patients with rheumatoid arthritis (RA), low-dose glucocorticoids are associated with an increased risk for vertebral fracture, but not with overall or non-vertebral fractures, show findings from a UK-based retrospective cohort study.

“Therefore, we can hypothesise that the beneficial effect of low-dose [glucocorticoid] therapy on suppressing the background inflammation of RA could probably be enough to offset its negative effect on bone synthesis in most fracture sites but not in vertebrae,” say Patrick Souverein (Utrecht University, the Netherlands) and colleagues.

They analyzed data from 15,123 patients above 50 years of age (average 68.8 years) who were diagnosed with RA between 1997 and 2017. In all, 7039 patients were taking oral glucocorticoids (mean treatment duration 3.7 years) and 8084 were not. These people were followed up for an average of 8.1 and 6.2 years, respectively, during which time there were 1640 osteoporotic fracture events.

The incidence rate of fracture events was comparable between patients currently taking a mean daily prednisone equivalent dose of 7.5 mg or less and those who had not taken glucocorticoids for at least 12 months, at 20.3 and 15.7 per 1000 person–years, respectively, giving a nonsignificant hazard ratio (HR) of 1.14 after adjusting for various factors including sex, BMI, smoking status, and alcohol use.

But in an analysis of specific fracture types, the investigators found a significant 59% elevated risk for clinical vertebral fracture in those currently taking low-dose glucocorticoids relative to those who stopped taking them at least 12 months before. The risk for other osteoporotic fracture types, including of the hip, humerus, forearm, pelvis, and ribs, was not increased.

“Clinicians should be aware that even in RA patients who receive low daily glucocorticoid doses, the risk of clinical vertebral fracture is increased,” the researchers stress in Rheumatology.

The risk for osteoporotic fractures was also significantly increased at higher glucocorticoid doses, the team reports, with incidence rates of 23.3 and 27.9 per 1000 person–years for those taking mean daily doses of 7.6–14.9 mg/day and at least 15 mg/day, respectively. This translated to significant adjusted HRs of 1.38 and 1.84 compared with patients who had not used glucocorticoids for at least 12 months.

“The results remained unchanged regardless of a short-term or a long-term oral glucocorticoid use” at the low daily dose, explain Souverein et al, whereas long-term use at the high glucocorticoid daily dose was associated with a significant 52% increased risk for osteoporotic fracture.

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Rheumatology 2021; doi:10.1093/rheumatology/keab548