Background
Methods
Data source
Study population
Follow-up
Outcome definition
Covariates
Statistical analysis
Results
Basic characteristics
PMR | GCA | |||
---|---|---|---|---|
Variables | Present N = 12,136 n (%) | Non-present N = 46,238 n (%) | Present N = 2673 n (%) | Non-present N = 10,423 n (%) |
Follow up time; median (IQR) | 9.27 (5.74–12.36) | 9.59 (5.97–12.61) | 9.13 (5.87–12.38) | 9.97 (6.23–13.00) |
Total fractures | 1689 (13.92) | 5173 (11.19) | 371 (13.88) | 1,142 (10.96) |
Fracture site | ||||
Wrist | 464 (27.47) | 1568 (30.31) | 118 (31.81) | 356 (31.17) |
Vertebra | 276 (16.34) | 482 (9.32) | 72 (19.41) | 123 (10.77) |
Humerus | 220 (13.03) | 693 (13.40) | 35 (9.43) | 145 (12.70) |
Hip | 563 (33.33) | 1844 (35.65) | 115 (31.00) | 419 (36.69) |
Other | 166 (9.83) | 586 (11.33) | 31 (8.36) | 99 (8.67) |
Male, n (%) | 3729 (30.73) | 14,078 (30.45) | 774 (28.96) | 2981 (28.60) |
Mean age (SD) | 72.04 (9.70) | 71.49 (9.52) | 71.12 (9.91) | 70.69 (9.76) |
Body mass index, kg/m2 | ||||
< 18.5 | 161 (1.33) | 676 (1.46) | 42 (1.57) | 140 (1.34) |
18.5–25 | 3723 (32.55) | 14,031 (30.35) | 795 (29.74) | 3102 (29.76) |
25–30 | 3950 (32.55) | 13,401 (28.98) | 844 (31.58) | 2941 (28.22) |
> 30 | 1919 (15.81) | 6200 (13.41) | 417 (15.60) | 1412 (13.55) |
Missing | 2383 (19.64) | 11,930 (25.80) | 575 (21.51) | 2828 (27.13) |
Current smoker | ||||
Yes | 1568 (12.92) | 6045 (13.07) | 500 (18.71) | 1454 (13.95) |
No | 9286 (76.52) | 32,579 (70.46) | 1858 (69.51) | 7111 (68.22) |
Missing | 1282 (10.56) | 7614 (16.47) | 315 (11.78) | 1858 (17.83) |
Alcohol (units per week) | ||||
Never/Ex-drinker | 2972 (24.49) | 10,000 (21.63) | 708 (26.49) | 2329 (22.34) |
1–9 | 3285 (27.07) | 12,087 (26.14) | 705 (26.37) | 2589 (24.84) |
≥ 10 | 1453 (11.97) | 5247 (11.35) | 275 (10.29) | 1105 (10.60) |
Missing | 4426 (36.47) | 18,904 (40.88) | 985 (36.85) | 4400 (42.21) |
Consultation for falls | 3771 (31.07) | 11,504 (24.88) | 849 (31.76) | 2612 (25.06) |
Charlson comorbidity index; median (IQR) | 3 (1–4) | 1 (0–3) | 2 (1–4) | 1 (0–3) |
Proton pump inhibitors | 7715 (63.57) | 20,710 (44.79) | 1749 (65.43) | 4670 (44.80) |
Bisphosphonate | 1479 (12.19) | 829 (1.79) | 413 (15.45) | 194 (1.86) |
Methotrexate | 706 (5.82) | 211 (0.46) | 122 (4.56) | 53 (0.51) |
> 1 Glucocorticoid prescription after index | 10,738 (88.48) | 5894 (12.75) | 2232 (83.50) | 1443 (13.84) |
Glucocorticoids treatment length; Median months (IQR) | 15.74 (6.51–34.36) | 0.99 (0.23–3.07) | 12.93 (4.01–32.49) | 1.05 (0.23–5.13) |
Risk of fracture
Variables | Present | Non-present | Unadjusted HR (95% CI) | Adjusted HR (95% CI)a | ||
---|---|---|---|---|---|---|
Number with fracture | Rate per 10,000 person-years (95% CI) | Number with fracture | Rate per 10,000 person-years | |||
PMR | ||||||
Overall | 1689 | 148.05 (141.16–155.28) | 5173 | 115.67 (112.56–118.87) | 1.29 (1.22–1.36) | 1.63 (1.54–1.73) |
Sex
| ||||||
Male | 244 | 68.79 (60.68–77.99) | 707 | 52.07 (48.37–56.06) | 1.32 (1.15–1.53) | 1.54 (1.33–1.81) |
Female | 1445 | 183.81 (174.57–193.54) | 4466 | 143.4 (139.25–147.67) | 1.29 (1.22–1.37) | 1.61 (1.52–1.72) |
Age in years
| ||||||
40–50 | 16 | 45.58 (27.93–74.41) | 48 | 32.55 (24.53–43.2) | 1.40 (0.81–2.41) | 1.92 (1.01–3.69) |
50–60 | 116 | 81.29 (67.77–97.52) | 264 | 46.04 (40.81–51.94) | 1.78 (1.43–2.2) | 2.23 (1.79–2.79) |
60–70 | 357 | 112.33 (101.26–124.61) | 1018 | 78.56 (73.88–83.53) | 1.44 (1.28–1.62) | 1.85 (1.56–2.10) |
70–80 | 753 | 161.12 (150.01–173.04) | 2555 | 138.51 (133.25–143.99) | 1.17 (1.08–1.26) | 1.51 (1.38–1.64) |
≥ 80 | 447 | 251.34 (229.08–275.75) | 1288 | 210.89 (199.68–222.72) | 1.21 (1.08–1.34) | 1.61 (1.43–1.81) |
GCA | ||||||
Overall | 371 | 147.15 (132.91–162.91) | 1142 | 109.52 (103.35–116.06) | 1.36 (1.22–1.53) | 1.67 (1.49–1.88) |
Sex
| ||||||
Male | 49 | 66.62 (50.35–88.15) | 127 | 42.37 (35.61–50.42) | 1.59 (1.15–2.2) | 1.62 (1.17–2.24) |
Female | 322 | 180.31 (161.66–201.12) | 1015 | 136.6 (128.45–145.27) | 1.34 (1.19–1.51) | 1.67 (1.47–1.90) |
Age in years
| ||||||
40–50 | 4 | 35.23 (13.22–93.86) | 9 | 18.87 (9.82–36.26) | 1.87 (0.63–5.58) | 1.98 (0.66–5.94) |
50–60 | 18 | 55.2 (34.78–87.61) | 46 | 34.94 (26.17–46.65) | 1.56 (0.9–2.71) | 2.27 (1.25–4.15) |
60–70 | 85 | 112.74 (91.15–139.45) | 257 | 78.19 (69.19–88.36) | 1.49 (1.17–1.89) | 1.79 (1.40–2.30) |
70–80 | 181 | 185.8 (160.61–214.94) | 579 | 141.96 (130.85–154) | 1.34 (1.13–1.57) | 1.65 (1.39–1.95) |
≥ 80 | 83 | 234.75 (189.31–291.1) | 251 | 197.88 (174.85–223.94) | 1.20 (0.93–1.54) | 1.48 (1.13–1.94) |
Risk by fracture site
Variables | Present | Non-present | Unadjusted HR (95% CI) | Adjusted HR (95% CI)a | ||
---|---|---|---|---|---|---|
Number with fracture | Rate per 10,000 person-years (95% CI) | Number with fracture | Rate per 10,000 person-years | |||
PMR | ||||||
Wrist | 464 | 40.67 (37.14–44.55) | 1568 | 35.06 (33.37–36.84) | 1.16 (1.05–1.29) | 1.70 (1.52–1.90) |
Vertebra | 276 | 24.19 (21.50–27.22) | 482 | 10.78 (9.86–11.78) | 2.25 (1.94–2.61) | 2.57 (2.19–3.02) |
Humerus | 220 | 19.28 (16.90–22.01) | 693 | 15.50 (14.38–16.69) | 1.25 (1.07–1.45) | 1.63 (1.39–1.91) |
Hip | 563 | 49.35 (45.44–53.60) | 1844 | 41.23 (39.39–43.16) | 1.20 (1.10–1.32) | 1.45 (1.31–1.60) |
Unspecified | 166 | 14.55 (12.50–16.94) | 586 | 13.10 (12.08–14.21) | 1.14 (0.96–1.35) | 1.26 (1.06–1.51) |
GCA | ||||||
Wrist | 118 | 46.80 (39.08–56.06) | 356 | 34.14 (30.77–37.88) | 1.37 (1.12–1.68) | 1.84 (1.49–2.28) |
Vertebra | 72 | 28.56 (22.67–35.98) | 123 | 11.80 (9.88–14.08) | 2.44 (1.84–3.23) | 2.97 (2.21–3.99) |
Humerus | 35 | 13.88 (9.97–19.33) | 145 | 13.91 (11.82–16.36) | 1.01 (0.70–1.45) | 1.19 (0.81–1.73) |
Hip | 115 | 45.61 (37.99–54.76) | 419 | 40.18 (36.51–44.22) | 1.16 (0.95–1.42) | 1.39 (1.13–1.72) |
Unspecified | 31 | 12.30 (8.65–17.48) | 99 | 9.49 (7.80–11.56) | 1.37 (0.91–2.05) | 1.32 (0.87–2.00) |
Risk by prescriptions
Variables | Number of patients | Number with fracture | Rate per 10,000 person-years (95% CI) | Unadjusted HR (95% CI) | Adjusted HR (95% CI)a |
---|---|---|---|---|---|
PMR | |||||
Methotrexate | |||||
No | 11,430 | 1614 | 151.32 (144.11–158.89) | Reference | Reference |
Yes | 706 | 75 | 101.03 (80.57–126.69) | 0.65 (0.52–0.83) | 0.96 (0.75–1.21) |
Glucocorticoid average daily dose (quintiles) | |||||
Quintile 1 (1–4.9 mg) | 2148 | 281 | 135.72 (120.74–152.55) | Reference | Reference |
Quintile 2 (4.9–6.1 mg) | 2148 | 286 | 139.86 (124.56–157.05) | 1.03 (0.88–1.22) | 1.12 (0.95–1.32) |
Quintile 3 (6.1–7.5 mg) | 2147 | 291 | 141.52 (126.16–158.75) | 1.04 (0.88–1.23) | 1.16 (0.99–1.37) |
Quintile 4 (7.5–10.0 mg) | 2148 | 283 | 141.32 (125.78–158.78) | 1.04 (0.88–1.23) | 1.27 (1.08–1.50) |
Quintile 5 (10.0–73.3 mg) | 2147 | 367 | 196.70 (177.57–217.89) | 1.46 (1.25–1.71) | 1.85 (1.59–2.17) |
GCA | |||||
Methotrexate | |||||
No | 2551 | 353 | 147.51 (132.90–163.73) | Reference | Reference |
Yes | 122 | 18 | 140.38 (88.45–222.82) | 0.94 (0.58–1.50) | 1.36 (0.84–2.19) |
Glucocorticoid average daily dose (quintiles) | |||||
Quintile 1 (1.1–5.7 mg) | 447 | 52 | 118.06 (80.96–154.93) | Reference | Reference |
Quintile 2 (5.7–7.5 mg) | 446 | 63 | 147.64 (115.33–188.99) | 1.26 (0.87–1.81) | 1.51 (1.05–2.19) |
Quintile 3 (7.5–9.8 mg) | 447 | 59 | 138.05 (106.85–178.18) | 1.17 (0.81–1.70) | 1.46 (1.00–2.12) |
Quintile 4 (9.8–13.5 mg) | 446 | 57 | 138.33 (106.70–179.34) | 1.18 (0.81–1.71) | 1.58 (1.08–2.30) |
Quintile 5 (13.5–83.9 mg) | 446 | 72 | 181.18 (143.81–228.25) | 1.54 (1.08–2.20) | 2.09 (1.46–2.99) |