Abstract
Purpose :
Non-infectious uveitis (NIU) patients are often exposed to high-dose systemic corticosteroids (CS), yet little is known about the risk of osteoporosis/bone fracture in these patients or their adherence to recommended screening protocols. This study assessed the rate of dual-energy x-ray absorptiometry (DXA) monitoring of CS-exposed NIU patients. It also compared the risk of osteoporosis/bone fractures with cohorts of rheumatoid arthritis (RA) patients and normal controls.
Methods :
Using data from a commercial and Medicare Advantage claims database, cohorts were created from NIU and RA patients given a cumulative dose of ≥900mg of oral prednisone (or bioequivalent dose of alternative corticosteroids (CS)). Patients were included in the analysis if they had at least 2 years of data prior to the date of reaching the minimum cumulative dose of oral CS, did not have a history of a DXA scan in the previous 18 months, and were ≥18 years old. NIU patients were excluded if they had any diagnosis of infectious uveitis or uveitis associated with systemic inflammatory disease at any time. RA patients were excluded if they were diagnosed with any form of uveitis. Patients were allowed to re-enter the analysis after DXA scan testing if the above criteria were again met. Cox proportional hazard regression estimated the hazard ratio of receiving DXA screening. A separate cohort analysis was conducted to compare the risk of osteoporosis/bone fractures in NIU patients versus matched normal controls, independent of CS use.
Results :
77,630 observations of NIU patients were compared with 80,862 observations of RA patients. During the follow-up period, 17,825 and 24,639 DXA scans were performed in NIU and RA patients, respectively. The adjusted hazard ratio (aHR) of NIU patients to have a DXA scan was 0.64 (95%CI:0.63-0.65; p<0.001) with respect to RA patients. After propensity score matching, the aHR of getting osteoporosis or a bone fracture of NIU patients was 0.95 (95%CI:0.93-0.98; p<0.001) compared to normal controls.
Conclusions :
NIU patients are 36% less likely to receive a DXA scan after high-dose CS exposure compared with RA patients. No elevated risk of osteoporosis for NIU patients was found compared to normal controls.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.