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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Medicine 1/2018

Risk of fracture among patients with polymyalgia rheumatica and giant cell arteritis: a population-based study

Zeitschrift:
BMC Medicine > Ausgabe 1/2018
Autoren:
Zoe Paskins, Rebecca Whittle, Alyshah Abdul Sultan, Sara Muller, Milica Blagojevic-Bucknall, Toby Helliwell, Samantha Hider, Edward Roddy, Christian Mallen
Wichtige Hinweise

Electronic supplementary material

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.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
Zusatzmaterial
Additional file 1: Table S1. Read codes for exposure and outcome definition. (DOCX 13 kb)
12916_2017_987_MOESM1_ESM.docx
Additional file 2: Algorithm for deriving glucocorticoid average dose and duration. (DOCX 22 kb)
12916_2017_987_MOESM2_ESM.docx
Literatur
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