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

Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis
Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis
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 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. 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
risk, hip, fractures, medical records, body mass index, bone, glucocorticoids, time, rheumatoid arthritis, research, spine, risk factors, proportional hazards models, mass, disease, activity, smoking, methods
0004-3591
3104-3112
Staa, T.P.
9b46fcd7-19de-40bc-a13e-2cbf47c1de53
Geusens, P.
4ff22618-fc20-494f-aa5d-2747d6b66f65
Bijlsma, J.W.
7cb4fea9-4b22-4ba9-8bfc-01eef45503ef
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Staa, T.P.
9b46fcd7-19de-40bc-a13e-2cbf47c1de53
Geusens, P.
4ff22618-fc20-494f-aa5d-2747d6b66f65
Bijlsma, J.W.
7cb4fea9-4b22-4ba9-8bfc-01eef45503ef
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6

Staa, T.P., Geusens, P., Bijlsma, J.W., Leufkens, H.G. and Cooper, C. (2006) Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis and Rheumatism, 54 (10), 3104-3112.

Record type: Article

Abstract

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 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. 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

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More information

Published date: 2006
Keywords: risk, hip, fractures, medical records, body mass index, bone, glucocorticoids, time, rheumatoid arthritis, research, spine, risk factors, proportional hazards models, mass, disease, activity, smoking, methods
Organisations: Dev Origins of Health & Disease

Identifiers

Local EPrints ID: 61534
URI: http://eprints.soton.ac.uk/id/eprint/61534
ISSN: 0004-3591
PURE UUID: 7101f11e-d20e-4e76-8719-8ff4ee266e56
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 04 Sep 2008
Last modified: 18 Mar 2024 02:44

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Contributors

Author: T.P. Staa
Author: P. Geusens
Author: J.W. Bijlsma
Author: H.G. Leufkens
Author: C. Cooper ORCID iD

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