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Impact of rheumatoid arthritis and its management on falls, fracture and bone mineral density in UK Biobank

Impact of rheumatoid arthritis and its management on falls, fracture and bone mineral density in UK Biobank
Impact of rheumatoid arthritis and its management on falls, fracture and bone mineral density in UK Biobank
Objectives: rheumatoid arthritis (RA) is a systemic chronic inflammatory disease which presents with polyarthritis in addition to extra-articular manifestations. Historically, studies have shown a link between RA and adverse musculoskeletal outcomes but these studies were reported before the widespread use of biologic therapies. The aim of this study was therefore to investigate associations between RA, RA medications and bone mineral density, falls and fractures, using UK Biobank data. Methods: diagnosis of RA was made using Hospital Episode Statistics (HES) ICD-10 coding. We assessed RA relationships with estimated bone mineral density (eBMD) from heel quantitative ultrasound measurements, self-reported falls (in last year) and HES recorded fracture, adjusted for age, ethnicity, BMI, smoking status and physical activity. Results: of 502,543 participants, 3849 (1.4%) of women and 1643 (0.7%) of men had a diagnosis of RA. Median age of the participants was 57 years (IQR 50 - 63) in women and 58 (IQR 50 - 64) in men. RA was associated with lower eBMD (men: β -0.244, 95% CI -0.378, -0.110 p<0.001; women: β -0.217, 95% CI -0.297, -0.138 p<0.001) a reported fall in the last year (men: OR 1.54, 95% CI 1.26, 1.87 p<0.001; women: OR 1.36, 95% CI 1.19, 1.56 p<0.001) and fracture in women (OR 1.76, 95% CI 1.43, 2.16 p<0.001). Corticosteroid therapy in men (β -0.934, 95% CI -1.565, -0.304 p=0.004) and disease modifying anti-rheumatic drug (DMARD) use in both sexes (men: β -0.437, 95% CI -0.761, -0.112 p=0.008; women: β -0.243, 95% CI -0.421, -0.065 p=0.007), but not biologic therapy, were associated with a lower eBMD with RA. Conclusions: RA was associated with lower eBMD, increased falls and fracture. Corticosteroid and DMARD therapy, but not biologic therapy, were associated with lower eBMD.
1664-2392
Clynes, Michael
b860d3b7-12ee-42b8-8cd5-1e1abfccbee2
Jameson, Karen
d5fb142d-06af-456e-9016-17497f94e9f2
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1
Clynes, Michael
b860d3b7-12ee-42b8-8cd5-1e1abfccbee2
Jameson, Karen
d5fb142d-06af-456e-9016-17497f94e9f2
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1

Clynes, Michael, Jameson, Karen, Prieto-Alhambra, Daniel, Harvey, Nicholas, Cooper, Cyrus and Dennison, Elaine (2019) Impact of rheumatoid arthritis and its management on falls, fracture and bone mineral density in UK Biobank. Frontiers in Endocrinology, 10, [817]. (doi:10.3389/fendo.2019.00817).

Record type: Article

Abstract

Objectives: rheumatoid arthritis (RA) is a systemic chronic inflammatory disease which presents with polyarthritis in addition to extra-articular manifestations. Historically, studies have shown a link between RA and adverse musculoskeletal outcomes but these studies were reported before the widespread use of biologic therapies. The aim of this study was therefore to investigate associations between RA, RA medications and bone mineral density, falls and fractures, using UK Biobank data. Methods: diagnosis of RA was made using Hospital Episode Statistics (HES) ICD-10 coding. We assessed RA relationships with estimated bone mineral density (eBMD) from heel quantitative ultrasound measurements, self-reported falls (in last year) and HES recorded fracture, adjusted for age, ethnicity, BMI, smoking status and physical activity. Results: of 502,543 participants, 3849 (1.4%) of women and 1643 (0.7%) of men had a diagnosis of RA. Median age of the participants was 57 years (IQR 50 - 63) in women and 58 (IQR 50 - 64) in men. RA was associated with lower eBMD (men: β -0.244, 95% CI -0.378, -0.110 p<0.001; women: β -0.217, 95% CI -0.297, -0.138 p<0.001) a reported fall in the last year (men: OR 1.54, 95% CI 1.26, 1.87 p<0.001; women: OR 1.36, 95% CI 1.19, 1.56 p<0.001) and fracture in women (OR 1.76, 95% CI 1.43, 2.16 p<0.001). Corticosteroid therapy in men (β -0.934, 95% CI -1.565, -0.304 p=0.004) and disease modifying anti-rheumatic drug (DMARD) use in both sexes (men: β -0.437, 95% CI -0.761, -0.112 p=0.008; women: β -0.243, 95% CI -0.421, -0.065 p=0.007), but not biologic therapy, were associated with a lower eBMD with RA. Conclusions: RA was associated with lower eBMD, increased falls and fracture. Corticosteroid and DMARD therapy, but not biologic therapy, were associated with lower eBMD.

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Accepted/In Press date: 8 November 2019
e-pub ahead of print date: 26 November 2019

Identifiers

Local EPrints ID: 435813
URI: http://eprints.soton.ac.uk/id/eprint/435813
ISSN: 1664-2392
PURE UUID: 16620cc2-0a3e-4544-a0b5-7fef41beec8e
ORCID for Michael Clynes: ORCID iD orcid.org/0000-0001-7597-7658
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Elaine Dennison: ORCID iD orcid.org/0000-0002-3048-4961

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Date deposited: 21 Nov 2019 17:30
Last modified: 26 Nov 2021 06:13

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Contributors

Author: Michael Clynes ORCID iD
Author: Karen Jameson
Author: Daniel Prieto-Alhambra
Author: Nicholas Harvey ORCID iD
Author: Cyrus Cooper ORCID iD
Author: Elaine Dennison ORCID iD

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