RESEARCH - Increased fracture risk in patients with rheumatic disorders and other inflammatory diseases

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Journal of Rheumatology

Nov 2010

Increased Fracture Risk in Patients with Rheumatic Disorders and Other

Inflammatory Diseases — A Case-Control Study with 53,108 Patients with

Fracture

RÜDIGER J. WEISS, MARIUS C. WICK, PAUL W. ACKERMANN and SCOTT M. MONTGOMERY

+ Author Affiliations

From the Department of Molecular Medicine and Surgery, Section of

Orthopedics and Sports Medicine, Department of Medicine, Clinical

Epidemiology Unit, Karolinska University Hospital, Karolinska

Institutet, Stockholm, Sweden; Clinical Epidemiology and Biostatistics

Unit, Örebro University Hospital, Örebro, Sweden; and Department of

Radiology, Innsbruck Medical University, Innsbruck, Austria.

R.J. Weiss, MD, PhD, Orthopaedic Surgeon; P.W. Ackermann, MD, PhD,

Orthopaedic Surgeon, Department of Molecular Medicine and Surgery,

Section of Orthopedics and Sports Medicine, Karolinska University

Hospital, Karolinska Institutet; M.C. Wick, MD, PhD, Radiology

Consultant, Department of Radiology, Innsbruck Medical University;

S.M. Montgomery, PhD, Professor of Epidemiology, Department of

Medicine, Clinical Epidemiology Unit, Karolinska University Hospital,

Karolinska Institutet, Clinical Epidemiology and Biostatistics Unit,

Örebro University Hospital.

Abstract

Objective. To identify the risk of hip and vertebral fractures in

patients with rheumatic disorders (RD) and inflammatory bowel diseases

(IBD).

Methods. This population-based case-control study assessed the

fracture risk of patients with rheumatoid arthritis, juvenile

idiopathic arthritis (JIA), ankylosing spondylitis (AS), systemic

lupus erythematosus, polymyositis/dermatomyositis (PM/DM), systemic

sclerosis (SSc), Crohn’s disease, and ulcerative colitis (UC). The

study cohort comprised 53,108 patients with fracture (66% women) and

370,602 age-matched and sex-matched controls. Conditional logistic

regression analysis was performed and results were expressed as OR

with corresponding 95% CI.

Results. There was a statistically significant increased fracture risk

for all RD and for IBD compared with controls. The magnitude of

fracture risk was higher for patients with RD (OR 3, 95% CI 2.9–3.2)

than for those with IBD (OR 1.6, 1.4–1.8). The OR in RD ranged from

2.6 (1.3–4.9) for SSc to 4 (3.4–4.6) for AS. The largest increased

fracture risk for vertebral fractures was seen in AS (OR 7.1, 6–8.4)

and for hip fractures in JIA (OR 4.1, 2.4–6.9).

Conclusion. Our results highlight the existence of an increased

fracture risk from a variety of underlying causes in patients with RD

and IBD. In many inflammatory diseases, implementation of fracture

prevention strategies may be beneficial.

http://jrheum.org/content/37/11/2247.abstract

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