Table 4

Risk of incident fractures in patients with rheumatoid arthritis by opioid and SSRI treatment duration

N events/ N exposureAdjusted HR* (95% CI)
Opioid use
 Ever vs never use535/50821.45 (1.25 to 1.68)
 Treatment duration
 ≤1 month of use133/50821.66 (1.36 to 2.04)
 >1 month and ≤3 months of use172/39741.46 (1.20 to 1.78)
 >3 months of use230/23211.35 (1.12 to 1.64)
SSRI use
 Ever vs never use241/23691.18 (1.00 to 1.39)
 Treatment duration
 ≤1 month of use38/23691.00 (0.71 to 1.39)
 >1 month and ≤3 months of use84/19441.19 (0.94 to 1.52)
 >3 months of use119/11431.25 (1.01 to 1.55)
  • *Stratified by FRAX risk categories for MOF and adjusted for age, sex, ethnicity, RA duration, education level, insurance, rural residency, smoking, influenza vaccination, comorbidity index, BMI, HAQ, pain and patient global scores, prior osteoporosis diagnosis, use of osteoporosis specific medications, exercise, mental component score of SF-36, prior csDMARD and bDMARD counts, hospitalisation and calendar year.

  • BMI, body mass index; FRAX, Fracture Risk Assessment Tool; HAQ, Health Assessment Questionnaire; MOF, major osteoporotic fracture; RA, rheumatoid arthritis; SSRI, selective serotonin reuptake inhibitor; bDMARD, biological disease modifying antirheumatic drug; csDMARD, conventional synthetic disease modifying antirheumatic drug.