Rheumatoid arthritis patients who take opioids or antidepressants are likelier to fracture their bones, according to research presented at the 2017 American College of Rheumatology annual meeting in San Diego.

“Even at younger ages, RA is associated with a twofold increased risk of osteoporosis and fractures due to chronic inflammation and glucocorticoid use,” said lead author Gulsen Ozen, of University of Nebraska Medical Center, and colleagues. “More importantly, osteoporotic fractures significantly contribute to the disability, health-related costs and mortality with substantially higher complication in RA patients than the general population.”

“Given the burden of osteoporotic fractures and the suboptimal osteoporosis care, it’s highly important to identify factors associated with fracture risk, particularly modifiable ones, in RA patients,” Ozen added.

Ozen and colleagues drew upon data from 11,002 rheumatoid arthritis patients, who had 863 fractures — a rate of 16.5 percent. Patients who took more than 7.5 mg a day of glucocorticoid had a fracture rate of 34.1, more than double that of the broader group. And those taking strong opioids had a fracture incident rate of 40.4.

When patients took opioids or selective serotonin reuptake inhibitors (SSRIs) of any strength, researchers found significant increases in osteoporotic fracture risk. That increased risk started within the first month for those using opioids, while those taking SSRI saw increases that began after three months of antidepressants. And the longer patients took the drugs, the greater the risk was.

“Knowing the risks associated with the use of these medications can guide rheumatologists and other physicians in choosing the most appropriate management strategies in patients, particularly the ones who have a high fracture or fall risk,” Ozen said.

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