Study shows increase fracture risk in RA patients taking certain medications

by John Keenan, UNMC public relations | June 05, 2019

Image with caption: From left, Gulsen Ozen, M.D., Kaleb Michaud, Ph.D.

From left, Gulsen Ozen, M.D., Kaleb Michaud, Ph.D.

Patients with rheumatoid arthritis (RA) who take opioids, SSRIs or glucocorticoids have a higher risk of having a bone fracture, according to a new study published in "Annals of the Rheumatic Diseases" and co-written by Kaleb Michaud, Ph.D., associate professor of rheumatology, and Gulsen Ozen, M.D., a rheumatology resident, at UNMC.

Michaud is the senior author on the study, whose authors also include Sofia Pedro and Frederick Wolfe, M.D., of Forward, The National Databank for Rheumatic Diseases.

The group drew from Forward, a databank Drs. Michaud and Wolfe co-direct, which is made up of patient-reported information from people diagnosed with rheumatoid arthritis and many other rheumatic diseases. Reviewing information from more than 11,000 patients with RA, the study looked at disease-modifying antirheumatic drugs (DMARDS), proton-pump inhibitors, opioids, non-opioid analgesics such as Tylenol, psychotropic medications such as anti-depressants, glucocorticoid steroids and statins.

"We wanted to take a look at the possible fracture risk due to any of these drugs," Dr. Michaud said. "Folks with rheumatoid arthritis have a lot of other conditions that come along, including increased risk for fracture - but we don't know why. We usually assume it's because of the steroids - the main side effects of which are you're going to gain weight, lose sleep and get osteoporosis and subsequent fracture."

But the study pointed to increased fracture risk due to other drugs, as well.

"There definitely was an increased risk of fracture with any dose of glucocorticoid steroids, when you've used them for three months or more," Dr. Michaud said. "And this was dose-dependent, so the higher the dose, the greater the risk. The lowest dose has a 26% increase per year vs. a 57% increase for higher doses.

"But we saw similar increases for any kind of use of opioids -- again, dose dependent, the stronger the opioid, the greater the risk and you had an increased risk within just one month of use. These drugs may be impacting the body's ability to recreate or to tear down bone. But if you're taking the opioids, you may not be moving around as much, and therefore losing the strength in your muscles that you need to help protect your bones, as well. So, it might lead to a fall or overall worse structure of the bone.

"We also looked at SSRIs (selective serotonin reuptake inhibitors), which are very commonly taken in the general population, let alone in RA, and we saw an increased risk there."

Dr. Michaud and his collaborators hope that the study will be of help to physicians treating people with RA.

"This shows that not only is fracture increased due to just having RA, but also with some of the drugs you take for RA," he said. "We're getting a much more concrete idea of how that risk is increased. We hope that this will help re-caution physicians when they prescribe."

Myrna McColley
June 07, 2019 at 3:55 PM

Read this article if you have rheumatoid arthritis