In patients with rheumatoid arthritis (RA), longer duration and higher dose of oral glucocorticoids (GCs) increase the risk for vertebral fractures, but not the risk for hip and nonvertebral/nonhip fractures, according to a retrospective study published in the Journal of Rheumatology.

Researchers examined the Korean National Healthcare Claims database to evaluate patients with RA from 2010 and followed them through December 2013 to identify specific effects of GC treatment on various fracture types. A total of 11,599 fractures were observed in 9964 patients from a total of 138,240 patients with RA. In the RA cohort, GCs were used in the treatment of 68.2% of patients for >3 months. 

An adjusted analysis demonstrated that GC use for ≥6 months, a mean dose of ≥2.5 mg, and a highest daily dose of ≥10 mg all increased the risk for vertebral fractures in patients with RA. However, neither the duration nor the dose of oral GCs increased the risk for hip and nonvertebral/nonhip fracture in this population.

In addition, the effect of GC use on fracture risk was comparable in patients with RA who had and did not have underlying osteoporosis. Although there were some limitations to this study, 1 of the greatest strengths was the size of the database, which included almost the entire Korean database.

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The researchers concluded, “The longer the duration of GC use, the higher the mean dose; the greater the highest daily dose, the greater the risk of vertebral fracture. In contrast, neither the duration nor the dose of oral GC increased the risk of hip and nonvertebral/nonhip fractures in patients with RA.”

Reference

Kim D, Cho SK, Park B, Jang EJ, Bae SC, Sung YK. Glucocorticoids are associated with an increased risk for vertebral fracture in patients with rheumatoid arthritis [published online March 15, 2018]. J Rheumatol. doi:10.3899/jrheum.170054