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Analysis of a large US observational rheumatoid arthritis (RA) patients finds that opioids, SSRIs and glucocorticoids were associated with increased risk of fracture in RA, whereas statins and TNFi had a decreased vertebral fracture risk.
FORWARD is a longitudinal observational RA registry that assessed patients for osteoporosis-related site fractures (vertebra, hip, forearm and humerus) between 2001 and 2017. Fracture Risk Assessment Tool (FRAX) scores estimating for 10-year major osteoporotic fractures were calculated. Cox proportional hazard models stratified by FRAX were used to adjust for confounders.
A total of 11 412 patients, with a median followup of 3 years, experienced 914 fractures.
A significantly increased adjusted fracture risk was seen for:
- any dose glucocorticoids ≥3 months
- <7.5 mg/day HR 1.26 (1.07 to 1.48)
- ≥7.5 mg/day 1.57 (1.27 to 1.94))
- opioids (for weak: 1.37 (1.18 to 1.59); strong: 1.53 (1.24 to 1.88))
- Fracture risk with opioids increased within 1 month of use (1.66 (1.36 to 2.04))
- selective serotonin reuptake inhibitors (SSRIs) (1.37 (1.15 to 1.63)).
- with SSRIs >3 months of use (1.25 (1.01 to 1.55)).
Statins (0.77 (0.62 to 0.96)) and TNFi (0.72 (0.54 to 0.97)) were associated with reduction in vertebral fracture risk only. PPIs and other psychotropic medications were not associated with increased fracture risk.