van Staa T P, Geusens P, Bijlsma J W J, Leufkens H G M, Cooper C
MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK.
Arthritis Rheum. 2006 Oct;54(10):3104-12. doi: 10.1002/art.22117.
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 >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 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.
确定类风湿关节炎（RA）患者骨折风险是否增加，并评估其长期绝对骨折风险。
我们在英国全科医疗研究数据库中研究年龄≥40岁的RA患者，每位患者按年龄、性别、日历时间和医疗机构与3名对照患者匹配。通过计算机化医疗记录确定的新发骨折情况，在中位随访7.6年期间进行了评估。将RA患者与对照患者的骨折率针对吸烟、体重指数（BMI）和若干临床风险因素进行了校正，并使用Cox比例风险模型计算RA患者骨折的相对风险（RR）。然后制定了一个风险评分，以估计RA患者5年和10年的骨折风险。
共有30262例RA患者，其中2460例在随访期间发生骨折。与对照患者相比，RA患者骨折风险增加，在髋部最为明显（RR 2.0，95%置信区间[95%CI]1.8 - 2.3），在脊柱部位也是如此（RR 2.4，95%CI 2.0 - 2.8）。骨折风险大幅升高（在髋部）的指标包括RA病程＞10年（RR 3.4，95%CI 3.0 - 3.9）、低BMI（RR 3.9，95%CI 3.1 - 4.9）以及使用口服糖皮质激素（RR 3.4，95%CI 3.0 - 4.0）。长期风险概况建模显示，例如，对于一名65岁患有长期RA的女性，其风险因素还包括低BMI、骨折病史以及频繁使用口服糖皮质激素，其5年髋部骨折风险为5.7%（95%CI 5.3 - 6.1%）。
RA患者骨质疏松性骨折风险增加。这种风险增加归因于疾病活动和口服糖皮质激素的使用。
