RESEARCH - Clinical assessment of the long-term risk of fracture in patients with RA

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Arthritis Rheum. 2006 Sep 28;54(10):3104-3112 [Epub ahead of print]

Clinical assessment of the long-term risk of fracture in patients with

rheumatoid arthritis.

Staa TP, Geusens P, Bijlsma JW, Leufkens HG, C.

MRC Epidemiology Resource Centre, University of Southampton, Southampton,

UK, Utrecht Institute for Pharmaceutical Sciences, Utrecht University,

Utrecht, The Netherlands, and General Practice Research Database, London,

UK.

OBJECTIVE: To determine whether patients with rheumatoid arthritis (RA) have

an increased risk of fracture, and to estimate their long-term absolute

fracture risk. METHODS: We studied patients with RA ages >/=40 years in the

British General Practice Research Database, each matched by age, sex,

calendar time, and practice to 3 control patients. Incident fractures, as

recorded in the computerized medical records, were ascertained over a median

followup of 7.6 years. The fracture rate in RA patients compared with

controls was adjusted for smoking, body mass index (BMI), and several

clinical risk factors, and proportional hazards models were used to

calculate the relative risk (RR) of fracture in RA. A risk score was then

developed to provide an estimate of the 5- and 10-year fracture risk among

RA patients. RESULTS: There were 30,262 patients with RA, of whom 2,460

experienced a fracture during followup. Compared with controls, patients

with RA had an increased risk of fracture, which was most marked at the hip

(RR 2.0, 95% confidence interval [95% CI] 1.8-2.3) and spine (RR 2.4, 95% CI

2.0-2.8). Indicators of a substantially elevated risk of fracture (at the

hip) included >10 years' duration of RA (RR 3.4, 95% CI 3.0-3.9), low BMI

(RR 3.9, 95% CI 3.1-4.9), and use of oral glucocorticoids (RR 3.4, 95% CI

3.0-4.0). Modeling of the long-term risk profiles revealed that, for

example, in a woman age 65 years with longstanding RA whose risk factors

also included low BMI, a history of fracture, and frequent use of oral

glucocorticoids, the 5-year risk of hip fracture was 5.7% (95% CI 5.3-6.1%).

CONCLUSION: Patients with RA are at increased risk of osteoporotic

fractures. This increased risk is attributable to a combination of disease

activity and use of oral glucocorticoids.

PMID: 17009229

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

7009229

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