NEW YORK (Reuters Health), Nov 2 - Patients with rheumatoid arthritis (RA) are at increased risk of fractures of the extremities, pelvis, and spine, as well as hip, even when they are not treated with glucocorticoids, results of a European study suggest.
The risks of osteoporosis and hip fracture are recognized complications of RA, the study authors indicate in their report, published in the October issue of Arthritis and Rheumatism. Still, little is known about how RA affects fracture risk at other sites, and whether the increased risk is due primarily to use of oral glucocorticoids or the underlying inflammatory disease.
Dr. Cyrus Cooper, from the University of Southampton in the U.K., and colleagues performed a large population-based study to more clearly elucidate the relationship between RA and fractures. They drew their data from the General Practice Research Database of the U.K. between 1987 and 2002. Each patient with RA was matched to three control patients without a history of RA, matched by age, gender, date, and practice.
Their cohort included roughly 30,000 patients with RA and 91,000 control subjects. During the study period, approximately 2,500 RA patients experienced a fracture. The relative risk (RR) of fracture was estimated after adjusting for BMI, smoking fracture and fall history, and treatment in the prior six months with bisphosphonates, hormone replacement therapy, and thiazides.
Patients with RA had an increased risk of fracture (RR = 1.5), particularly for the hip and spine but also for the pelvis, humerus, and tibia/fibula. The risk increased with the duration of the disease, and remained elevated after excluding patients who had been taking oral glucocorticoids.
Dr. Cooper's group concludes that "patients with RA are at a substantially increased risk of fractures at the hip, pelvis, vertebrae, humerus, and tibia/fibula." Independent risk factors were long-standing disease, low body mass index, and use of oral glucocorticoids. They maintain that disease activity and use of glucocorticoids were associated with similar magnitudes of effect.
Last Updated: 2006-11-01 12:34:21 -0400 (Reuters Health)
Arthritis Rheum 2006;54:3104-3112.
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