阿片类药物使用与类风湿关节炎成人非椎骨骨折风险：基于行政数据库的巢式病例对照研究。

Opioid Use and Risk of Nonvertebral Fractures in Adults With Rheumatoid Arthritis: A Nested Case-Control Study Using Administrative Databases.

机构信息

McGill University and McGill University Health Centre, Montreal, Quebec, Canada, and Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

McGill University and McGill University Health Centre, Montreal, Quebec, Canada.

出版信息

Arthritis Rheumatol. 2016 Jan;68(1):83-91. doi: 10.1002/art.39422.

DOI:10.1002/art.39422

PMID:26360963

Abstract

OBJECTIVE

To assess the risk of nonvertebral fractures in patients with rheumatoid arthritis (RA) who were exposed to opioids.

METHODS

A population-based, nested case-control study was conducted using health services administrative databases (Quebec, Canada) from 1997 to 2012. Among RA patients, cases of nonvertebral fractures from 2007 to 2012 were identified using a validated algorithm. The date of the first fracture was the index date for the case and his/her matched control. Controls were selected using incidence density sampling and were matched 5:1 to cases for age, sex, and date of RA diagnosis. Opioid exposure was classified as current use, recent past use, remote past use, and nonuse. Conditional logistic regression was used to assess the association of nonvertebral fractures with opioid exposure, adjusting for comorbidity, indicators of RA severity, drugs influencing fracture risk, and health care utilization.

RESULTS

In total, 1,723 cases and 8,046 controls were identified. Among these patients, 2,595 (722 cases and 1,873 controls) had been exposed to opioids. Current use (versus nonuse) increased the risk of nonvertebral fracture. Cumulative current use of opioids according to the quartile distribution was also associated with the risk of nonvertebral fracture: for continuous use for 1-20 days before the index date, odds ratio (OR) 11.49 (95% confidence interval [95% CI] 8.81-14.99); for 21-155 days, OR 1.75 (95% CI 1.31-2.33); for 156-355 days, OR 1.54 (95% CI 1.17-2.04); and for ≥356 days, OR 1.73 (95% CI 1.31-2.30). No association between the risk of nonvertebral fractures and recent past use or remote past use of opioids was observed.

CONCLUSION

Among RA patients, the risk of nonvertebral fracture is increased in those treated with opioids.

摘要

目的

评估接受阿片类药物治疗的类风湿关节炎（RA）患者发生非椎体骨折的风险。

方法

本研究采用基于人群的巢式病例对照研究，使用了 1997 年至 2012 年期间的医疗服务管理数据库（加拿大魁北克省）。通过验证算法确定了 2007 年至 2012 年期间的非椎体骨折病例，并将其作为病例，将他/她的匹配对照纳入研究。通过发病率密度抽样选择对照，并按年龄、性别和 RA 诊断日期与病例进行 5:1 匹配。阿片类药物的使用情况分为当前使用、近期使用、远期使用和未使用。采用条件逻辑回归来评估非椎体骨折与阿片类药物暴露之间的关联，同时调整了合并症、RA 严重程度指标、影响骨折风险的药物以及医疗保健的利用情况。

结果

共确定了 1723 例病例和 8046 例对照。其中，2595 例（722 例病例和 1873 例对照）患者曾暴露于阿片类药物中。与未使用相比，当前使用（阿片类药物）增加了非椎体骨折的风险。根据四分位分布的累积当前使用阿片类药物也与非椎体骨折的风险相关：在索引日期前使用 1-20 天，比值比（OR）为 11.49（95%置信区间[95%CI]为 8.81-14.99）；使用 21-155 天，OR 为 1.75（95%CI 为 1.31-2.33）；使用 156-355 天，OR 为 1.54（95%CI 为 1.17-2.04）；使用≥356 天，OR 为 1.73（95%CI 为 1.31-2.30）。近期和远期使用阿片类药物与非椎体骨折风险之间未见关联。