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Association of use of rehabilitation services with development of osteoporosis among patients with rheumatoid arthritis: a nationwide population-based cohort study

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Abstract

Summary

This is the first study that has found that rehabilitation services (RS) intervention, following the onset of rheumatoid arthritis (RA), may significantly reduce the risk of osteoporosis in RA patients. Those patients who received more than five sessions of RS had the greatest benefit for the prevention of osteoporosis.

Introduction

People with rheumatoid arthritis have increased risk of developing osteoporosis (OP). It remains unclear whether use of rehabilitation services can reduce the risk of developing OP. We conducted a longitudinal cohort study to compare the effect of RS on the risk of OP in Taiwanese individuals with RA.

Methods

A national health insurance database was used to identify 2693 newly diagnosed RA patients, 20–70 years old, between 1998 and 2007. Among them, 808 received RS after the onset of RA (RS users) and 1885 patients did not receive RS (non-RS users). All enrollees were followed until the end of 2012 to record incident cases of OP. A Cox proportional hazards regression model was used to compute adjusted hazard ratios (aHRs) for the relationship of use of RS with OP.

Results

During the 15-year follow-up, 358 RS users and 1238 non-RS users developed OP, corresponding to incidence rates of 87.24 and 129.27 per 1000 person-years, respectively. Use of RS was significantly associated with a lower risk of OP (aHR 0.62; 95% confidence interval [CI] = 0.56–0.71). Those who received more than five sessions of RS had the greatest benefit (aHR 0.47; 95% CI = 0.38–0.56).

Conclusions

The integration of RS into the clinical management of patients with RA may decrease their risk of developing OP.

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Acknowledgements

The study is based on data from the National Health Insurance Research Database, provided by the Bureau of National Health Insurance (Department of Health) and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institutes.

Funding

This research was supported by Dalin Tzuchi Hospital (Grant Number DTCRD105-I-14). Liu LC, Lu MC, Wang SY, and Livneh H contributed equally to this work.

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi, 62247, Taiwan

    L.-C. Liu & S.-Y. Wang

  2. Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi, 62247, Taiwan

    M.-C. Lu & N.-S. Lai

  3. School of Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien, 97004, Taiwan

    M.-C. Lu & N.-S. Lai

  4. Rehabilitation Counseling Program, Portland State University, Portland, OR, 97207-0751, USA

    H. Livneh

  5. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan

    T.-Y. Tsai

  6. Department of Nursing, Tzu Chi University of Science and Technology, 880 Chien-Kuo Road Section 2, Hualien, 62247, Taiwan

    T.-Y. Tsai

  7. Department of Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi, 62247, Taiwan

    T.-Y. Tsai

Authors
  1. L.-C. Liu
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  2. M.-C. Lu
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  3. S.-Y. Wang
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  4. H. Livneh
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  5. N.-S. Lai
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  6. T.-Y. Tsai
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Corresponding authors

Correspondence to N.-S. Lai or T.-Y. Tsai.

Ethics declarations

This study was conducted in accordance with the Helsinki Declaration and was evaluated and approved by the local Institutional Review Board and Ethics Committee of Buddhist Dalin Tzu Chi Hospital, Taiwan (No. B10004021-2).

Conflicts of interest

None.

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Liu, LC., Lu, MC., Wang, SY. et al. Association of use of rehabilitation services with development of osteoporosis among patients with rheumatoid arthritis: a nationwide population-based cohort study. Osteoporos Int 29, 1897–1903 (2018). https://doi.org/10.1007/s00198-018-4569-7

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  • DOI: https://doi.org/10.1007/s00198-018-4569-7

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