Dr. van Staa was previously employed by Procter & Gamble. Dr. Cooper has received honoraria (less than $10,000) from Procter & Gamble, Lilly, and Servier.
Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis
Article first published online: 28 SEP 2006
Copyright © 2006 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 54, Issue 10, pages 3104–3112, October 2006
How to Cite
Staa, T. P. V., Geusens, P., Bijlsma, J. W. J., Leufkens, H. G. M. and Cooper, C. (2006), Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis & Rheumatism, 54: 3104–3112. doi: 10.1002/art.22117
- Issue published online: 28 SEP 2006
- Article first published online: 28 SEP 2006
- Manuscript Accepted: 16 JUN 2006
- Manuscript Received: 2 DEC 2005
- Medical Research Council, Arthritis Research Campaign, and Procter & Gamble Pharmaceuticals, UK
To determine whether patients with rheumatoid arthritis (RA) have an increased risk of fracture, and to estimate their long-term absolute fracture risk.
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 Cox 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.
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%).
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.