The online version of this article (doi:https://doi.org/10.1186/s12916-017-0987-1) contains supplementary material, which is available to authorized users.
Glucocorticoids are associated with increased fracture risk and are the mainstay of treatment in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). However, fracture risk in these conditions has not been previously quantified. The aim of this study was to quantify the risk of fracture among patients with PMR and GCA.
A retrospective cohort study was conducted using primary care records from the UK-based Clinical Practice Research Datalink. Individuals aged 40 years and over, with incident diagnoses of PMR or GCA were separately identified from 1990–2004 and followed up until 2015. For each exposed individual, four age-, sex- and practice-matched controls were randomly selected. Incidence rates of fracture per 10,000 person-years were calculated for each disease group and hazard rates were compared to the unexposed using Cox regression models.
Overall, 12,136 and 2673 cases of PMR and GCA, respectively, were identified. The incidence rate of fracture was 148.05 (95% CI 141.16–155.28) in PMR and 147.15 (132.91–162.91) in GCA per 10,000 person-years. Risk of fracture was increased by 63% in PMR (adjusted hazard ratio 1.63, 95% CI 1.54–1.73) and 67% in GCA (1.67, 1.49–1.88) compared to the control populations. Fewer than 13% of glucocorticoid-treated cases were prescribed bisphosphonates.
This study reports, for the first time, a similar increase in fracture risk for patients with PMR and GCA. More needs to be done to improve adherence to guidelines to co-prescribe bisphosphonates. Further research needs to identify whether lower glucocorticoid starting doses and/or aggressive dose reduction reduces fracture risk.
Fardet L, Petersen I, Nazareth I. Monitoring of patients on long-term glucocorticoid therapy: a population-based cohort study. Medicine (Baltimore). 2015;94(15):e647. CrossRef
Bultink I, Harvey N, Lalmohamed A, et al. Elevated risk of clinical fractures and associated risk factors in patients with systemic lupus erythematosus versus matched controls: a population-based study in the united kingdom. Osteoporosis Int. 2014;25(4):1275–83. CrossRef
Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010;49(8):1594–7. CrossRef
Vestergaard P, Rejnmark L, Mosekilde L. Methotrexate, azathioprine, cyclosporine, and risk of fracture. Calcif Tissue Int. 2006;79:69A75.
Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2010;49(1):186–90. CrossRef
Rossini M, Viapiana O, Vitiello M, Malavolta N, La Montagna G, Bongi SM, Di Munno O, Nuti R, Manzini CU, Ferri C, Bogliolo L. Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study. Reumatismo. 2017;69(1):30–9. CrossRefPubMed
Kanis J, Johnell O, Odén A, Johansson H, McCloskey E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporosis Int. 2008;19(4):385–97. CrossRef
Bone and Tooth Society, Royal College of Physicians of London. Glucocorticoid-Induced Osteoporosis: Guidelines for Prevention and Treatment. London: Royal College of Physicians; 2002.
National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary: Giant Cell Arteritis. 2014. https://cks.nice.org.uk/giant-cell-arteritis. Accessed 2 Feb 2017.
National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary: Polymyalgia Rheumatica. 2013. https://cks.nice.org.uk/polymyalgia-rheumatica. Accessed 2 Feb 2017.
Helliwell T. Polymyalgia Rheumatica in Primary Care: An Exploration of the Challenges of Diagnosis and Management Using Survey and Qualitative Methods. PhD Thesis. Staffordshire: Keele University; 2016.
- Risk of fracture among patients with polymyalgia rheumatica and giant cell arteritis: a population-based study
Alyshah Abdul Sultan
- BioMed Central
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