People with autoimmune diseases who take immunosuppressants face higher risk of fractures

People with autoimmune diseases who take immunosuppressants face higher risk of fractures

New research shows that people with autoimmune diseases who take immunosuppressants have a higher risk of fractures. 1

The new retrospective study, led by Dr. Feng-Chen Kao of I-Shou University School of Medicine in Kaohsiung, Taiwan, aimed to find out whether immunosuppressants are associated with fractures in patients with autoimmune diseases. Researchers already know that patients with autoimmune diseases are at higher risk for fractures, but they weren’t sure whether long-term use of immunosuppressants increases the risk of injury.

“Our results suggest that across four autoimmune diseases, the risk of fracture is higher in the immunosuppressant subgroup compared with the non-immunosuppressive subgroup,” the researchers wrote. “These results are consistent with current research on this type of disease.” Rheumatoid Arthritis contradicts the belief that use of immunosuppressants may prevent fractures.”

Autoimmune diseases affect millions of people around the world, and the disease can impact a person’s quality of life. 2 People with autoimmune diseases take immunosuppressants, which control symptoms by suppressing the immune system and reducing inflammation. 1

Investigators collected data from the Taiwan National Health Insurance Research Database, which covers 99.9% of Taiwan’s population. They selected patients diagnosed with the autoimmune disease between 2000 and 2014 who had either psoriatic arthritis or psoriatic arthritis. Rheumatoid arthritis; ankylosing spondylitis; or systemic lupus erythematosus. The control group had no autoimmune disease and was selected from the same database. Researchers matched the autoimmune disease cohort and the non-autoimmune disease cohort at a ratio of 1:4 based on age, sex, index data, and comorbidity propensity scores.

The research team examined prescription records, which contained order dates, dosages, routes for each prescription and the number of days each drug was prescribed. They measured medication use from the time of diagnosis to 365 days after diagnosis.

The research team divided participants into 2 groups based on their use of immunosuppressants. Patients who took immunosuppressant drugs for more than 30 days were placed in the immunosuppressant subcohort (n = 7,277), whereas patients who did not take any immunosuppressant drugs during the 365-day window were placed in the non-immunosuppressant subcohort (n = 29,108) ). ). The primary outcome was patients diagnosed with a shoulder, spine, wrist, or hip fracture—patients with a shoulder, spine, wrist, or hip fracture before 365 days were excluded from the study.

Overall, patients with autoimmune diseases had a 1.14 times greater risk of fracture than those without autoimmune diseases. The adjusted subdistribution hazard ratios were 1.27 (95% CI, 1.01 – 1.58) for shoulder fractures, 1.43 (95% CI, 1.26 – 1.62) for spine fractures, and 0.95 (95% CI, 0.75 – 1.22) for wrist fractures. , the value for hip fracture was 1.67 (95% CI, 1.38 – 2.03).

Researchers found that a large proportion of patients with autoimmune diseases had comorbidities such as chronic lung disease, ulcers and diabetes. Baseline distributions were similar between the immunosuppressant and non-immunosuppressive subgroups except for some comorbidities, including congestive heart failure, dementia, ulcers, chronic liver disease, diabetes, and leukemic or lymphoma tumors.

The risk of hip fracture was found to be relatively high, especially among patients with systemic lupus erythematosus who received immunosuppressant drugs (95% CI, 2.17 – 5.15). In addition, the incidence of hip fracture was significantly higher in the immunosuppressive subgroup than in the non-immunosuppressive subgroup.

The findings suggest that taking immunosuppressants may increase the risk of fractures, particularly hip fractures, in patients with autoimmune diseases.

“Given the possible increased fracture risk with immunosuppressant use, clinicians must be aware of this potential complication and take appropriate measures to reduce risk,” the researchers wrote. “These measures may include close patient monitoring, life modification ways to promote bone health, and the use of bone-protective medications such as bisphosphonates or denosumab.”

refer to

  1. Kao FC, Hsu YC, Tu YK, Chen TS, Wang HH, Lin J. Long-term use of immunosuppressants increases the risk of fractures in patients with autoimmune diseases: an 18-year population-based cohort study. biomedicine. 2023;11(10):2764.
  2. Wang, L.; Wang, FS; Gershwin, ME. Human autoimmune diseases: a comprehensive update. J.Intern. Medicine 2015, 278, 369–395. (Google Scholar) (Crossref)

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