Kim Dam, Cho Soo-Kyung, Choi Chan-Bum, Jun Jae-Bum, Kim Tae-Hwan, Lee Hye-Soon, Lee Jisoo, Lee Shin-Seok, Yoo Dae-Hyun, Yoo Wan-Hee, Sung Yoon-Kyoung, Bae Sang-Cheol
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Republic of Korea.
Rheumatol Int. 2016 Sep;36(9):1205-14. doi: 10.1007/s00296-016-3453-z. Epub 2016 Mar 10.
Rheumatoid arthritis (RA) patients have high risk for osteoporosis and fracture. We aimed to identify the incidence rate and risk factors of fractures in Asian RA patients. A total of 3557 RA patients in the KORean Observational study Network for Arthritis (KORONA) were included and observed over a mean follow-up of 18 months. A fracture was assessed as total, major, or minor fractures; major fracture was defined as a vertebral or hip fracture, and the other fractures were classified as minor fractures. The standardized incidence ratio (SIR) of fracture in RA patients was calculated compared with general population, and possible risk factors for fractures were explored using multivariable logistic regression analyses. A total of 194 patients with 215 fractures were observed, and the SIR of the total fracture in RA patients was 2.2 [95 % confidence interval (CI) 1.9-2.6]. The SIRs of major and minor fractures were 1.5 (CI 1.1-2.0) and 3.0 (CI 2.5-3.7), respectively. Advanced age [odds ratio (OR) 1.03, CI 1.02-1.05, p < 0.01] and having history of prior fracture (OR 2.17, CI 1.54-3.08, p < 0.01) were risk factors for total fractures. In addition, higher HAQ increased fracture risk (OR 2.02, CI 1.05-3.89, p = 0.04), whereas the use of bisphosphonate showed protective effect for future fractures (OR 0.34, CI 0.14-0.87, p = 0.02) in patients with osteoporosis. RA patients had a 2.2-fold increased risk of fractures as compared with general population. In Asian RA patients, advanced age and history of prior fracture were the most important risk factors for new fractures.
类风湿关节炎（RA）患者发生骨质疏松和骨折的风险较高。我们旨在确定亚洲RA患者骨折的发生率及危险因素。韩国关节炎观察研究网络（KORONA）中共有3557例RA患者被纳入研究，并进行了平均18个月的随访观察。骨折被评估为全部骨折、严重骨折或轻微骨折；严重骨折定义为椎体或髋部骨折，其他骨折则归类为轻微骨折。计算RA患者骨折的标准化发病率比（SIR），并与普通人群进行比较，同时使用多变量逻辑回归分析探索可能的骨折危险因素。共观察到194例患者发生215处骨折，RA患者全部骨折的SIR为2.2[95%置信区间（CI）1.9 - 2.6]。严重骨折和轻微骨折的SIR分别为1.5（CI 1.1 - 2.0）和3.0（CI 2.5 - 3.7）。高龄[比值比（OR）1.03，CI 1.02 - 1.05，p < 0.01]和既往有骨折史（OR 2.17，CI 1.54 - 3.08，p < 0.01）是全部骨折的危险因素。此外，较高的健康评估问卷（HAQ）评分增加骨折风险（OR 2.02，CI 1.05 - 3.89，p = 0.04），而对于骨质疏松患者，使用双膦酸盐对未来骨折具有保护作用（OR 0.34，CI 0.14 - 0.87，p = 0.02）。与普通人群相比，RA患者骨折风险增加2.2倍。在亚洲RA患者中，高龄和既往骨折史是新发骨折最重要的危险因素。
