Background/Purpose: Patients with rheumatoid arthritis (RA) have a 2-fold increase in risk for osteoporosis compared to the general population. About 30-50% of RA patients experience fragility fractures, while pain management frequently includes prescription opioids, despite a paucity of long-term data on safety and efficacy. The impact of osteoporosis and opioid use on healthcare utilization and mortality in persons with RA is not well defined. We aimed to 1) compare mortality and unplanned healthcare use in those with RA with vs. without osteoporosis, and 2) compare 30-day mortality and unplanned healthcare use in those with RA and osteoporosis with vs. without opioid use.

Methods: This is a retrospective cohort analysis using the OptumLabs Data Warehouse, a large administrative claims database containing de-identified health information. We included commercially insured and Medicare Advantage beneficiaries, >50 years old, with RA. The outcomes included mortality and unplanned healthcare use, i.e. ED use, unplanned hospitalization, and urgent care. We identified persons with a diagnosis of RA between 1/1/2005-12/31/2023. For aim 1, we categorized those with RA by osteoporosis diagnosis status (1 inpatient or 2 outpatient claims with a diagnosis of osteoporosis, or at least 1 medication fill for an antiosteoporotic medication). For aim 2, we included everyone with a diagnosis of RA and osteoporosis, and categorized individuals by whether or not they had at least one opioid fill. We 1:1 propensity score (PS) matched individuals based on the following variables: age, sex, race/ethnicity, geographic location, insurance type, comorbid conditions of interest, including the Elixhauser comorbid index, and use of glucocorticoids. After matching, a standardized mean difference < 0.10 was deemed acceptable. Cox proportional hazards regression was used to compare individuals with osteoporosis and without, in terms of mortality and unplanned healthcare use. Logistic regression was used to compare individuals with an opioid fill to those without a fill, in terms of 30-day mortality and unplanned healthcare use. As a sensitivity check we repeated our analysis using inverse probability of treatment weighting (IPTW) instead of propensity score matching.

Results: Among individuals with RA (862 matched pairs), those with osteoporosis had higher ED use [hazard ratio (HR): 1.23, 95% confidence interval (CI): 1.06 – 1.41; p-value = 0.005] and unplanned hospitalizations [HR: 1.26, 95% CI: 1.02 – 1.56; p-value = 0.03] compared to those without osteoporosis (Figure 1). The IPTW model showed similar results. Among individuals with RA and osteoporosis; the PS matched model did not yield any differences in mortality or healthcare utilization; however, the IPTW model (644 with an opioid fill vs. 189 without a fill) showed that those with an opioid fill had higher 30-day ED use [HR: 5.82, 95% CI: 1.77 – 19.19; p-value = 0.004] compared to those without a fill.

Conclusion: The presence of osteoporosis in RA and opioid use in patients with osteoporosis and RA pose a significant risk for unplanned healthcare utilization. Effective prevention and management of osteoporosis in RA, as well as judicious use of opioids can help prevent these unfavorable outcomes.

Figure 1: Cumulative risk of mortality and unplanned healthcare utilization among individuals with RA, 1:1 matched osteoporosis vs. no osteoporosis

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-osteoporosis-and-opioid-use-on-mortality-and-unplanned-healthcare-utilization-among-patients-with-rheumatoid-arthritis/