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

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Arthritis Rheum. 2006 Oct;54(10):3104-12.

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

rheumatoid arthritis.

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

MRC Epidemiology Resource Centre, University of Southampton, Southampton, 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 >or=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/pubmed/17009229

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