Risk of incident fractures in patients with rheumatoid arthritis by opioid and SSRI treatment duration
| N events/ N exposure | Adjusted HR* (95% CI) | |
| Opioid use | ||
| Ever vs never use | 535/5082 | 1.45 (1.25 to 1.68) |
| Treatment duration | ||
| Non-use | 379/8526 | Referent |
| ≤1 month of use | 133/5082 | 1.66 (1.36 to 2.04) |
| >1 month and ≤3 months of use | 172/3974 | 1.46 (1.20 to 1.78) |
| >3 months of use | 230/2321 | 1.35 (1.12 to 1.64) |
| SSRI use | ||
| Ever vs never use | 241/2369 | 1.18 (1.00 to 1.39) |
| Treatment duration | ||
| Non-use | 673/9983 | Referent |
| ≤1 month of use | 38/2369 | 1.00 (0.71 to 1.39) |
| >1 month and ≤3 months of use | 84/1944 | 1.19 (0.94 to 1.52) |
| >3 months of use | 119/1143 | 1.25 (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.