Parallel glucocorticoid, PPI use linked to increased fracture risk in RA
medwireNews: Concomitant use of oral glucocorticoids (GCs) and proton pump inhibitors (PPIs) significantly increases the risk for osteoporotic fractures in people with rheumatoid arthritis (RA), with the combined effect greater than that for each drug class alone, research suggests.
“Considering the increasing life expectancies and high consumption of PPIs among elderly patients, fracture risk assessment could be considered when a patient with RA is co-prescribed oral GCs and PPIs,” say Frank de Vries (Utrecht University, the Netherlands) and co-investigators.
The findings are based on an analysis of data for 12,351 patients (69% women) aged 50 years and older (mean 68 years) with RA who were registered in the UK Clinical Practice Research Datalink between 1997 and 2017.
Of these, 4254 had at least one co-prescription of an oral GC and PPI during a mean 9.1 years of follow-up, during which time there were 264 fractures, corresponding to a rate of 24.4 fractures per 1000 person–years.
By comparison, the rate was 15.5 per 1000 person–years among the 2136 individuals who only received GCs, 16.7 per 1000 person–years among the 2823 people who only received PPIs, and 10.5 per 1000 person–years among the 3138 participants who received neither drug.
After adjustment for potential confounders, the researchers found that current GC and PPI co-use was associated with a significant 60% increased risk for osteoporotic fracture when compared with no use, with current use defined as having a prescription in the 6 months prior to the fracture.
This risk increase was significantly higher than the 23% increased risk observed with GC monotherapy and 22% increased risk with PPI monotherapy.
By contrast, there was no significantly increased fracture risk among people with recent (7–12 months) or past (>1 year) co-prescriptions for a GC and a PPI.
de Vries et al also report that the fracture risk did not increase with increasing dose or duration of PPI use but observed some differences in risk by fracture type.
Specifically, the hazard ratios for hip, pelvis, vertebral, and rib fractures were 1.45, 2.47, 2.84, and 4.03, respectively, with concomitant versus no use of oral GCs and PPIs. Conversely, there were no significantly increased risks for humerus and forearm fractures.
The study findings are published in the Annals of the Rheumatic Diseases.
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