School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
Int J Rheum Dis. 2024 Aug;27(8):e15286. doi: 10.1111/1756-185X.15286.
Patients with rheumatoid arthritis (RA) are at a higher risk of osteoporotic fractures. Studies have shown that patients with Sjogren's syndrome (SS) and systemic lupus erythematosus (SLE) experienced an increase in bone mineral density (BMD) after receiving hydroxychloroquine (HCQ) treatment, indicating a potential protective effect against osteoporosis. Therefore, this study is to examine the relationship between HCQ usage and the risk of osteoporosis in patients diagnosed with RA.
The retrospective cohort study used data from Taiwan's National Health Insurance Research Database (NHIRD) covering the period from January 2010 to December 2018, which included 14 050 newly diagnosed RA patients, subsequently divided into two groups: HCQ users and non-users. Propensity score matching (PSM) based on sex, age, urbanization, insured unit type, insured area, and comorbidities was conducted to match the groups. The primary outcome assessed was the evaluation of the risk of osteoporosis by employing a multivariable Cox proportional hazard regression model to calculate the adjusted hazard ratio (aHR).
After PSM, a total of 6408 RA patients were included in the analysis (3204 HCQ users and 3204 non-users). There was no significantly higher risk of osteoporosis in HCQ users compared with non-users, aHR = 0.99 (95% CI: 0.82-1.196). Additionally, different durations of HCQ usage demonstrated a neutral effect on the risk of osteoporosis [HCQ <90 days, aHR = 0.88 (95% CI: 0.585-1.324); HCQ 90-180 days, aHR = 0.941 (95% CI: 0.625-1.418); HCQ >180 days, aHR = 1.019 (95% CI: 0.832-1.249)].
The study indicates that there is no significant association between the use of HCQ and the risk of osteoporosis in patients with RA.
类风湿关节炎（RA）患者发生骨质疏松性骨折的风险较高。研究表明，接受羟氯喹（HCQ）治疗后，干燥综合征（SS）和系统性红斑狼疮（SLE）患者的骨密度（BMD）增加，表明其对骨质疏松症具有潜在的保护作用。因此，本研究旨在探讨 RA 患者使用 HCQ 与骨质疏松症风险之间的关系。
本回顾性队列研究使用了台湾全民健康保险研究数据库（NHIRD）的数据，涵盖了 2010 年 1 月至 2018 年 12 月期间的 14050 例新诊断为 RA 的患者，随后将其分为 HCQ 使用者和非使用者两组。采用基于性别、年龄、城市化程度、参保单位类型、参保地区和合并症的倾向评分匹配（PSM）对两组进行匹配。采用多变量 Cox 比例风险回归模型评估骨质疏松症风险，计算调整后的危险比（aHR）作为主要结局。
经过 PSM 后，共有 6408 例 RA 患者纳入分析（HCQ 使用者 3204 例，非使用者 3204 例）。与非使用者相比，HCQ 使用者发生骨质疏松症的风险无显著升高，aHR=0.99（95%CI：0.82-1.196）。此外，不同时长的 HCQ 用药对骨质疏松症风险无显著影响[HCQ<90 天，aHR=0.88（95%CI：0.585-1.324）；HCQ 90-180 天，aHR=0.941（95%CI：0.625-1.418）；HCQ>180 天，aHR=1.019（95%CI：0.832-1.249）]。
本研究表明，RA 患者使用 HCQ 与骨质疏松症风险之间无显著关联。
