Bone Abstracts

Background and objectives: Fracture in rheumatoid arthritis (RA) patient is more frequent than general population. One of the important reasons is use of glucocorticoid (GC) for treatment of RA. In this study, we aimed to identify the effect of GC on fracture of different site.

Methods: Among RA patients ≧19 years, we established a retrospective cohort using Korean national healthcare claims database from Jan 2010 to Dec 2010, and then followed up until Dec 2013. RA patients who experienced fracture in year 2009 were excluded. Fractures were identified on the basis of selected ICD-10 codes and information about clinic visit until last visit. Information about oral GC use was collected until incidence of fracture or last visit. In multivariable logistic regression analysis, each of variables such as duration, mean dose, and highest daily dose of GC were adjusted for age, gender, payer type, type of institution, physician’s specialities, comorbidities and medication.

Results: The 11 599 fractures in 9964 RA patients were observed among total of 138 240 RA patients. The 68% of patients used oral GC more than 3 months. Mean dose of GC was 6.1±4.7 mg and their highest daily dose was 16.20±15.8 mg. In adjusted analysis, duration of GC ≧6 months (OR 1.36, P<0.01 for total fracture; OR 1.76, P<0.01 for vertebral fracture), mean dose of GC ≧2.5 mg (OR 1.17–1.34, P<0.01 in total fracture; OR 1.37–1.71, P<0.01 in vertebral fracture) and highest daily dose of GC ≧10 mg (OR 1.22–1.33, P<0.01 in total fracture; OR 1.23–1.75, P<0.03 in vertebral fracture) increased the risk of total and vertebral fracture. However, in hip fracture, neither duration nor dose of oral GC increased the risk.

Conclusion: Use of oral GC increased the risk of total and vertebral fracture, however, it did not increase the risk of hip fracture in RA patients.