RESEARCH - Stress fractures in rheumatoid arthritis

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Ann Rheum Dis. 2004 Dec;63(12):1690-2.

Stress fractures in rheumatoid arthritis: a case series and case-control

study.

Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, UK.

OBJECTIVE: To review cases of stress fracture in patients with rheumatoid

arthritis (RA) presenting to our service over a 10 year period; to identify

possible risk factors and test these in a case-control study. METHODS: A

retrospective case note review of all patients with a final diagnosis of

stress fracture, presenting between 1990 and 1999 was performed. A

case-control study of consecutive patients with RA, matched for age, sex and

duration of disease, attending the same clinics. RESULTS: Case series: 24

stress fractures were identified in 18 patients, representing 0.8% of the RA

clinic population; all were women, median age 69.5 years (range 47-79). Bone

mineral densitometry showed median T scores of -3.06 and -2.27 SD at the hip

and lumbar spine, respectively. Case-control study: In the stress fractures

group, past steroid doses were higher (p = 0.003). No significant

differences in the bone mineral density (BMD) T score at the hip or lumbar

spine were found (p = 0.59, p = 0.77).

CONCLUSIONS: Stress fractures are a significant cause of morbidity in RA.

Diagnosis is often delayed and presentation can be misleading. Past steroid

use, particularly at higher doses, confers an increased risk of stress

fracture, but the increased risk is not attributable to osteoporosis as

assessed by BMD.

PMID: 15547098

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=15547098

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