Risk of Non-Vertebral Fracture in Gout Compared to Rheumatoid Arthritis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Cohort
2.3. Outcome Definition
2.4. Covariate Assessment
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Risk of Non-Vertebral Fracture, Hip Fracture and All-Cause Death
3.3. Stratified Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Gout (n = 134,157) | RA (n = 134,157) | Standardized Difference * (%) |
---|---|---|---|
Demographics † | |||
Age, year, mean ± SD | 73.69 ± 6.52 | 73.69 ± 6.52 | 0.0 |
Female | 94,456 (70.41) | 94,456 (70.41) | 0.0 |
White race | 99,924 (74.48) | 115,625 (86.19) | 29.8 |
Osteoporotic fracture related comorbidities | |||
BMD test | 13,922 (10.38) | 33,274 (24.80) | 38.6 |
Prior fall | 5953 (4.44) | 5810 (4.33) | −0.5 |
Osteoporosis | 16,654 (12.41) | 44,135(32.90) | 50.5 |
Obesity | 23,598 (17.59) | 9802 (7.31) | −31.5 |
Prior fracture ‡ | 2649 (1.97) | 3426 (2.55) | 3.9 |
Prior hip fracture ‡ | 753 (0.56) | 1246 (0.93) | 4.3 |
Other comorbidities | |||
Comorbidity score, mean ± SD | 2.03 ± 2.66 | 1.03 ± 1.93 | −0.4 |
Smoking | 13,539 (10.09) | 13,277 (9.90) | −0.6 |
Alcoholism | 581 (0.43) | 278 (0.21) | −3.9 |
Dementia | 8879 (6.62) | 8172 (6.09) | −2.2 |
Parkinson | 1602 (1.19) | 1772 (1.32) | 1.2 |
Coronary heart diseases | 55,635 (41.47) | 39,839 (29.70) | −24.8 |
COPD | 38,012 (28.33) | 35,979 (26.82) | −3.4 |
Diabetes mellitus | 67,909 (50.62) | 37,643 (28.06) | −47.5 |
Heart failure | 33,290 (24.81) | 14,758 (11.00) | −36.6 |
Hypertension | 126,632 (94.39) | 101,379 (75.57) | −54.6 |
Hyperlipidemia | 115,472 (86.07) | 95,978 (71.54) | −36.1 |
Chronic kidney diseases | 46,420 (34.60) | 13,829 (10.31) | −60.8 |
Stroke | 24,349 (18.15) | 18,855 (14.05) | −11.2 |
Frailty index | |||
Robust | 35,902 (26.76) | 41,942 (31.26) | 9.9 |
Prefrail | 81,216 (60.54) | 81,327 (60.62) | 0.2 |
Mildly frail | 15,975 (11.91) | 10,389 (7.74) | −14.0 |
Moderately to severely frail | 1064 (0.79) | 499 (0.37) | −5.5 |
Osteoporosis medication | |||
Bisphosphonate | 10,061 (7.50) | 29,866 (22.26) | 42.4 |
PTH | 191 (0.14) | 941 (0.70) | 8.7 |
Calcitonin | 573 (0.43) | 1183 (0.88) | 5.6 |
Denosumab | 411 (0.31) | 1401 (1.04) | 8.9 |
Raloxifene | 1640 (1.22) | 2294 (1.71) | 4.1 |
Teriparatide | 191 (0.14) | 941 (0.70) | 8.7 |
Other medications | |||
Prior use of steroids | 41,047 (30.60) | 74,294 (55.38) | −51.7 |
Prior cumulative dose of prednisolone equivalent, mg, mean ± SD | 160.57 ± 540.52 | 673.19 ± 1096.69 | 0.59 |
0 | 93,110 (69.40) | 59,863 (44.62) | −51.7 |
>0 and ≤224 | 20,503 (15.28) | 12,786 (9.53) | −17.5 |
>224 | 20,544 (15.31) | 61,508 (45.85) | 70.3 |
Steroid injection | 10,357 (7.72) | 18,893 (14.08) | 20.5 |
TNF inhibitor | 0(0) | 13,061 (9.74) | 46.5 |
Methotrexate | 0(0) | 83,428 (62.19) | 181.4 |
Anticonvulsants | 21,499 (16.03) | 22,030 (16.42) | 1.1 |
Antipsychotic | 32,739 (24.40) | 32,007 (23.86) | −1.3 |
Benzodiazepines | 15,823 (11.79) | 17,571 (13.10) | 4.0 |
Beta blocker | 62,397 (46.51) | 44,015 (32.81) | −28.3 |
ACE inhibitor | 91,489 (68.20) | 63,783 (47.54) | −42.8 |
Calcium channel blocker | 54,211 (40.41) | 37,065 (27.63) | −27.2 |
Diuretics | 97,994 (73.04) | 58,219 (43.40) | −63.0 |
Statin | 80,794 (60.22) | 61,059 (45.51) | −29.8 |
NSAIDs | 64,465 (48.05) | 58,786 (43.82) | −8.5 |
Opioids | 58,529 (43.63) | 56,567 (42.16) | −3.0 |
Proton pump inhibitor | 44,834 (33.42) | 48,896 (36.45) | 6.4 |
SSRI | 21,975 (16.38) | 26,365 (19.65) | 8.5 |
Health care utilization, mean ± SD | |||
No. of all prescription drugs | 13.60 ± 6.49 | 12.08 ± 6.11 | −0.2 |
No. of ER visit | 0.86 ± 1.62 | 0.52 ± 1.12 | −24.1 |
No. of visits | 12.95 ± 9.16 | 14.21 ± 9.17 | 0.1 |
No. of hospitalization | 0.41 ± 0.87 | 0.24 ± 0.61 | −20.4 |
Gout Group | RA Group | IRR (95% CI) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Subgroup | No. of Patients | Cases | Person-Years | IR (95% CI) | No. of Patients | Cases | Person-Years | IR (95% CI) | ||
Non-vertebral fracture | ||||||||||
All patients | 134,157 | 3891 | 373,336 | 10.42 (10.10–10.75) | 134,157 | 5785 | 385,306 | 15.01 (14.63–15.40) | 0.69 (0.66–0.72) | |
Age, years | 65–74 | 81,439 | 1642 | 235,612 | 6.97 (6.64–7.32) | 81,439 | 2570 | 246,103 | 10.44 (10.04–10.85) | 0.67 (0.63–0.71) |
≥75 | 52,718 | 2249 | 137,723 | 16.33 (15.67–17.02) | 52,718 | 3215 | 139,202 | 23.10 (22.32–23.91) | 0.71 (0.67–0.75) | |
Sex | Women | 94,456 | 3258 | 254,914 | 12.78 (12.35–13.23) | 94,456 | 4854 | 263,895 | 18.39 (17.88–18.91) | 0.69 (0.66–0.72) |
Men | 39,701 | 633 | 118,421 | 5.35 (4.95–5.78) | 39,701 | 931 | 121,410 | 7.67 (7.19–8.18) | 0.70 (0.63–0.77) | |
Prior fracture | No | 131,508 | 3701 | 368,057 | 10.06 (9.74–10.39) | 130,731 | 5501 | 378,326 | 14.54 (14.16–14.93) | 0.69 (0.66–0.72) |
Yes | 2649 | 190 | 5278 | 35.99 (31.22–41.49) | 3426 | 284 | 6979 | 40.69 (36.22–45.71) | 0.88 (0.73–1.06) | |
365-d cumulative dose of steroids | 0 | 93,110 | 2561 | 264,162 | 9.69 (9.32–10.07) | 59,863 | 2473 | 177,812 | 13.91 (13.37–14.47) | 0.70 (0.66–0.74) |
0–224 mg | 20,503 | 634 | 56,134 | 11.29 (10.44–12.20) | 12,786 | 527 | 36,930 | 14.27 (13.10–15.54) | 0.79 (0.70–0.89) | |
>224 mg | 20,544 | 696 | 53,039 | 13.12 (12.18–14.13) | 61,508 | 2785 | 170,563 | 16.33 (15.73–16.95) | 0.80 (0.74–0.87) | |
TNF inhibitor | No | 134,157 | 3891 | 373,336 | 10.42 (10.10–10.75) | 121,096 | 5270 | 351,257 | 15.00 (14.60–15.41) | 0.69 (0.66–0.72) |
Yes | 13,061 | 515 | 34,048 | 15.13 (13.88–16.49) | NA | |||||
Hip fracture | ||||||||||
All patients | 134,157 | 1831 | 376,535 | 4.86 (4.64–5.09) | 134,157 | 3013 | 389,675 | 7.73 (7.46–8.01) | 0.63 (0.59–0.67) | |
Age, years | 65–74 | 81,439 | 588 | 237,454 | 2.48 (2.29–2.69) | 81,439 | 1142 | 248,645 | 4.59 (4.33–4.86) | 0.54 (0.49–0.60) |
≥75 | 52,718 | 1243 | 139,081 | 8.94 (8.46–9.45) | 52,718 | 1871 | 141,029 | 13.27 (12.68–13.89) | 0.67 (0.62–0.72) | |
Sex | Women | 94,456 | 1492 | 257,622 | 5.79 (5.50–6.09) | 94,456 | 2439 | 267,678 | 9.11 (8.76–9.48) | 0.64 (0.60–0.68) |
Men | 39,701 | 339 | 118,913 | 2.85 (2.56–3.17) | 39,701 | 574 | 121,996 | 4.71 (4.34–5.11) | 0.61 (0.53–0.70) | |
Prior fracture | No | 131,508 | 1755 | 371,107 | 4.73 (4.51–4.96) | 130,731 | 2880 | 382,493 | 7.53 (7.26–7.81) | 0.63 (0.59–0.67) |
Yes | 2649 | 76 | 5428 | 14.00 (11.18–17.53) | 3426 | 133 | 7181 | 18.52 (15.63–21.95) | 0.76 (0.57–1.01) | |
365-d cumulative dose of steroids * | 0 | 93,110 | 1218 | 266,342 | 4.57 (4.32–4.83) | 59,863 | 1257 | 179,791 | 6.99 (6.61–7.39) | 0.65 (0.60–0.70) |
0–224 mg | 20,503 | 304 | 56,640 | 5.37 (4.80–6.01) | 12,786 | 263 | 37,300 | 7.05 (6.25–7.96) | 0.76 (0.64–0.90) | |
>224 mg | 20,544 | 309 | 53,552 | 5.77 (5.16–6.45) | 61,508 | 1493 | 172,583 | 8.65 (8.22–9.10) | 0.67 (0.59–0.76) | |
TNF inhibitor | No | 134,157 | 1831 | 376,535 | 4.86 (4.64–5.09) | 121,096 | 2750 | 355,227 | 7.74 (7.46–8.03) | 0.63 (0.59–0.67) |
Yes | 13,061 | 263 | 34,447 | 7.63 (6.76–8.61) | NA |
Adjustment | Hazard Ratio (95% CI) |
---|---|
Non-vertebral fracture | |
Model 1 | 0.69 (0.66–0.72) |
Model 2 | 0.78 (0.75–0.82) |
Model 3 | 0.75 (0.72–0.79) |
Final model | 0.84 (0.80–0.88) |
Hip fracture | |
Model 1 | 0.62 (0.59–0.66) |
Model 2 | 0.72 (0.67–0.76) |
Model 3 | 0.68 (0.64–0.73) |
Final model | 0.76 (0.71–0.82) |
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Cho, S.-K.; Liu, J.; Jin, Y.; Kim, S.C. Risk of Non-Vertebral Fracture in Gout Compared to Rheumatoid Arthritis. J. Clin. Med. 2021, 10, 4655. https://doi.org/10.3390/jcm10204655
Cho S-K, Liu J, Jin Y, Kim SC. Risk of Non-Vertebral Fracture in Gout Compared to Rheumatoid Arthritis. Journal of Clinical Medicine. 2021; 10(20):4655. https://doi.org/10.3390/jcm10204655
Chicago/Turabian StyleCho, Soo-Kyung, Jun Liu, Yinzhu Jin, and Seoyoung C. Kim. 2021. "Risk of Non-Vertebral Fracture in Gout Compared to Rheumatoid Arthritis" Journal of Clinical Medicine 10, no. 20: 4655. https://doi.org/10.3390/jcm10204655