Table 5.
Predictors of osteoporosis treatment and BMD testing as separate outcomes in patients with rheumatoid arthritis
| Variables | OP treatment, HR (95% CI) |
ACR recommended OP treatment, HR (95% CI) |
OP treatment excluding HRT, HR (95%CI) |
BMD testing, HR (95% CI) |
|
|---|---|---|---|---|---|
|
| |||||
| Age groups | |||||
|
| |||||
| <40 years (referent) | 1.0 | 1.0 | 1.0 | 1.0 | |
|
| |||||
| 40–50 years | 1.31 (0.97–1.77) | 1.74 (1.04–2.94) | 1.99 (1.21–3.28) | 2.10 (1.69–2.62) | |
|
| |||||
| 51–64 years | 1.47 (1.06–2.03) | 2.45 (1.43–4.21) | 2.88 (1.71–4.84) | 2.96 (2.35–3.74) | |
|
| |||||
| ≥65 years | 1.54 (1.07–2.19) | 3.44 (1.96–6.05) | 4.08 (2.37–7.00) | 3.53 (2.76–4.52) | |
|
| |||||
| Gender | |||||
|
| |||||
| Women | |||||
| Premenopausal (referent) | 1.0 | 1.0 | 1.0 | 1.0 | |
| Postmenopausal | 1.86 (1.45–2.38) | 1.61 (1.11–2.33) | 1.66 (1.18–2.34) | 1.56 (1.33–1.83) | |
|
| |||||
| Men | 0.77 (0.58–1.01) | 0.85 (0.57–1.27) | 0.75 (0.52–1.09) | 0.54 (0.46–0.65) | |
|
| |||||
| Education level | 1.02 (0.99–1.05) | 1.00 (0.98–1.03) | 1.01 (0.99–1.04) | 1.03 (1.01–1.04) | |
|
| |||||
| No insurance | 0.88 (0.61–1.28) | 0.90 (0.55–1.49) | 0.83 (0.51–1.36) | 0.51 (0.39–0.67) | |
|
| |||||
| Residency in a rural area | 0.98 (0.88–1.10) | 1.03 (0.91–1.16) | 1.00 (0.89–1.13) | 0.88 (0.83–0.95) | |
|
| |||||
| Disease duration | 1.00 (0.99–1.00) | 1.00 (1.00–1.01) | 1.00 (1.00–1.01) | 1.00 (0.99–1.00) | |
|
| |||||
| Vaccination for influenza | 1.15 (1.03–1.28) | 1.11 (0.98–1.25) | 1.14 (1.02–1.28) | 1.13 (1.06–1.20) | |
|
| |||||
| Rheumatic Disease Comorbidity Index | 1.09 (1.03–1.15) | 1.01 (0.96–1.08) | 1.03 (0.97–1.09) | 0.99 (0.96–1.04) | |
|
| |||||
| BMI in categories | |||||
|
| |||||
| <18.5 kg/m2 | 1.10 (0.76–1.58) | 1.47 (1.05–2.05) | 1.35 (0.97–1.88) | 1.08 (0.87–1.33) | |
|
| |||||
| 18.5–24.9 kg/m2 (referent) | 1.0 | 1.0 | 1.0 | 1.0 | |
|
| |||||
| 25.0–29.9 kg/m2 | 0.66 (0.59–0.76) | 0.61 (0.53–0.70) | 0.64 (0.56–0.73) | 0.89 (0.83–0.96) | |
|
| |||||
| 30.0–39.9 kg/m2 | 0.58 (0.50–0.66) | 0.59 (0.51–0.69) | 0.57 (0.49–0.66) | 0.85 (0.78–0.92) | |
|
| |||||
| ≥40 kg/m2 | 0.40 (0.30–0.52) | 0.46 (0.34–0.63) | 0.42 (0.31–0.56) | 0.64 (0.55–0.74) | |
|
| |||||
| HAQ | 1.08 (0.99–1.16) | 0.98 (0.96–1.09) | 1.01 (0.93–1.10) | 0.99 (0.95–1.03) | |
|
| |||||
| Glucocorticoid use | |||||
|
| |||||
| Not-using (referent) | 1.0 | 1.0 | 1.0 | 1.0 | |
|
| |||||
| <3 months | 1.32 (1.02–1.72) | 1.45 (1.06–1.98) | 1.43 (1.06–1.92) | 1.22 (1.04–1.43) | |
|
| |||||
| 3–12 months | 1.30 (1.06–1.59) | 1.70 (1.35–2.13) | 1.70 (1.37–2.11) | 1.33 (1.18–1.50) | |
|
| |||||
| >12 months | 1.66 (1.46–1.90) | 1.93 (1.68–2.22) | 1.94 (1.70–2.22) | 1.48 (1.37–1.60) | |
|
| |||||
| Use of DMARDs | |||||
|
| |||||
| MTX monotherapy (referent) | 1.0 | 1.0 | 1.0 | 1.0 | |
|
| |||||
| Any TNFi | 1.16 (0.99–1.36) | 1.01 (0.86–1.20) | 1.06 (0.90–1.25) | 1.15 (1.06–1.26) | |
|
| |||||
| Non-TNFi bDMARDs | 1.29 (0.97–1.71) | 1.24 (0.90–1.71) | 1.31 (0.97–1.77) | 1.21 (1.01–1.45) | |
|
| |||||
| Any others | 1.11 (0.95–1.29) | 0.90 (0.77–1.06) | 0.94 (0.81–1.10) | 1.07 (0.98–1.16) | |
|
| |||||
| Prior fragility fracture | 1.35 (1.17–1.56) | 1.61 (1.37–1.88) | 1.55 (1.33–1.81) | 1.21 (1.11–1.32) | |
|
| |||||
| Prior diagnosis of OP | 1.58 (1.29–1.93) | 2.25 (1. 78–2.85) | 2.28 (1.83–2.85) | 1.38 (1.23–1.55) | |
|
| |||||
| 10-year major osteoporotic fracture risk categories by FRAX | |||||
|
| |||||
| Low (referent) | 1.0 | 1.0 | 1.0 | 1.0 | |
|
| |||||
| Medium | 0.98 (0.84–1.15) | 1.10 (0.92–1.32) | 1.07 (0.90–1.27) | 1.09 (0.99–1.20) | |
|
| |||||
| High | 1.07 (0.86–1.32) | 01.16 (0. 91–1.48) | 1.07 (0.85–1.34) | 0.96 (0.84–1.09) | |
OPTS=Osteoporosis treatment and screening; OPTS-ACR=ACR-recommended OP treatment and screening; ACR= American College of Rheumatology; HR=Hazard ratio; HRT= Hormone replacement therapy; RA= Rheumatoid arthritis; OA= Osteoarthritis; BMI= Body mass index; HAQ= Health assessment questionnaire; DMARD= Disease modifying antirheumatic drug; MTX=Methotrexate; TNFi= Tumor necrosis factor-α inhibitor; bDMARDs= Biologic disease modifying antirheumatic drugs; OP= Osteoporosis; FRAX= Fracture risk assessment tool.