OP fracture risk by concomitant use of oral GCs and PPIs in patients with rheumatoid arthritis
| By recency of use | Number of OP fractures (N=1411)* | IR per 1000 Pys | Age/sex-adjusted HR (95% CI) | Fully adjusted HR† (95% CI) |
| Non-use of GCs and PPIs | 325 | 10.5 | Reference | Reference |
| Current use‡ | ||||
| GCs and PPIs concomitantly | 264 | 24.4 | 1.93 (1.65 to 2.27) | 1.60 (1.35 to 1.89) |
| GCs alone | 178 | 15.5 | 1.34 (1.12 to 1.59) | 1.23 (1.03 to 1.47)§ |
| PPIs alone | 324 | 16.7 | 1.32 (1.14 to 1.54) | 1.22 (1.05 to 1.42)§ |
| Recent GC use‡ ¶ | 34 | 11.0 | 0.87 (0.62 to 1.23) | 0.82 (0.58 to 1.16) |
| Recent PPI useঠ| 49 | 16.0 | 1.21 (0.90 to 1.62) | 1.17 (0.87 to 1.57) |
| Past GC use‡ ¶ | 339 | 15.6 | 1.16 (1.01 to 1.33) | 1.13 (0.98 to 1.29) |
| Past PPI use‡ ¶ | 219 | 13.5 | 0.96 (0.82 to 1.13) | 0.94 (0.80 to 1.10) |
Statistically significantly increased HRs are shown in bold.
*1411 OP fracture events among all included patients with RA. The number of events in exposure groups do not sum to this total due to the overlap between recent and past use of GCs and PPIs.
†Adjusted at baseline for sex, body mass index, smoking status and alcohol use; during follow-up for age, a history of ankylosing spondylitis, chronic obstructive pulmonary disease, dementia, falls (in the past 7–12 months) and inflammatory bowel disease; and use in the past 6 months of antidepressants, paracetamol, non-selective non-steroidal anti-inflammatory drugs, cyclo-oxygenase-2 selective inhibitors, tramadol, opioids and conventional synthetic disease-modifying antirheumatic drugs.
‡Current, recent and past use refer to the last prescription within 6 months, 7–12 months and >12 months before a period, respectively.
§Statistically different from concomitant GC and PPI use, Wald test p<0.05.
¶Regardless of the use of the other drug.
GCs, glucocorticoids; IR, incidence rate; OP, osteoporotic; PPIs, proton pump inhibitors; Pys, person years.