RESEARCH - Fall-related risk factors and osteoporosis in women with RA

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Rheumatology Advance Access originally published online on July 13, 2004

Rheumatology 2004 43(10):1267-1271; doi:10.1093/rheumatology/keh304

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Paper

Fall-related risk factors and osteoporosis in women with rheumatoid

arthritis

H. Kaz Kaz1, D. 1,2, S. Kerry3, U. Chinappen2, K. Tweed1 and S.

Patel1,2

1 Department of Medicine and Rheumatology, St Helier Hospital, Carshalton, 2

Osteoporosis Unit, St 's Hospital and 3 Department of Community Health

Sciences, St 's Hospital Medical School, London, UK

Correspondence to: S. Patel, Department of Rheumatology, St Helier Hospital,

Carshalton SM5 1AA, UK. E-mail: Sanjeev.Patel@...

Background. Rheumatoid arthritis (RA) is associated with an increased risk

of osteoporotic fractures. Whilst numerous studies have demonstrated low

bone density in RA, few studies have examined the risk of falling, which is

another major contributor to the pathogenesis of fractures (particularly hip

fractures).

Objectives. The aim of this study was to see if fall risk is increased in

women with RA, define high-risk subgroups, and determine what proportion of

women have increased risk of hip fracture due to osteoporosis and due to

increased fall risk.

Methods. We performed a case-control study of older women with RA (n = 103)

compared with women without RA referred for open access bone densitometry (n

= 203). We measured bone density using dual-energy X-ray absorptiometry and

fall risk factors (visual acuity, ability to perform standups, and heel-toe

walking).

Results. More women with RA gave a history of a previous fall compared with

controls (54 vs 44%), although this was just short of being statistically

significant (difference 10%, 95% CI -2 to 22). Women with RA were more

likely to have abnormal heel-toe walking and inability to perform standups

compared with controls (P<0.001); however, visual acuity was similar between

cases and controls. Femoral neck osteoporosis was found in 31% and increased

fall risk in 68% of women with RA. Women with RA who underperformed in

heel-toe walking and were unable to do standups had significantly higher

ESR, Health Assessment Questionnaire score and tender joint count. RA

symptoms/signs localized to the knees and ankles were more likely to be

associated with the presence of fall risk factors.

Conclusions. Fall-related risk factors predictive of hip fracture are common

in women with RA. Fall risk needs to be considered when RA patients are

being treated for osteoporosis and further work needs to be done to help

reduce the risk of falling and fracture in women with RA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/43/10/1267

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