Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Department of Population Health Sciences, Division of Biostatistics and Data Science, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Arch Osteoporos. 2020 Sep 18;15(1):146. doi: 10.1007/s11657-020-00815-3.
Having rheumatoid arthritis (RA) or end-stage renal disease (ESRD) can lead to fractures. RA independently increases the risk of hip or other femur fracture in dialysis patients. Use of corticosteroids is a potentially modifiable risk factor for fractures among persons with RA and ESRD on dialysis.
Rheumatoid arthritis (RA) and end-stage renal disease (ESRD) both independently increase fracture risk; however, how RA and ESRD interplay to affect fracture risk is unknown. We aim to determine the association of RA with fracture in ESRD and identify risk factors for fracture in patients with RA and ESRD.
A retrospective cohort study was conducted using the United States Renal Data System (USRDS) to identify ESRD adults with and without a history of RA who initiated dialysis in 2005-2008. International Classification of Diseases, 9th Revision (ICD-9) codes were used to identify fractures following start of dialysis. Risk for incident fracture was compared between those with and without RA. Potential risk factors for fracture among persons with RA and ESRD were analyzed.
There were 754 persons with ESRD and RA, of whom 126 (17%) had any incident fracture. In multivariable adjusted final models, among ESRD patients, RA was an independent risk factor for hip/femur fracture (RR 1.28, 95% CI 1.01-1.64). Among persons with RA and ESRD, in final models, only corticosteroid use was a significant risk factor for both any incident (RR 2.00, 95% CI 1.40-2.87) and hip/femur (RR 1.97, 95% CI 1.24-3.11) fracture. Those with higher body mass index had a lower relative risk of hip/femur fracture (RR 0.95, 95% CI 0.91-0.99).
Among ESRD patients, those with RA have a 28% increased risk for hip or other femur fracture. Use of corticosteroids is a potentially modifiable risk factor for fractures among persons with RA and ESRD.
类风湿关节炎（RA）和终末期肾病（ESRD）均独立增加骨折风险；然而，RA 和 ESRD 如何相互作用影响骨折风险尚不清楚。我们旨在确定 RA 与 ESRD 患者骨折的关系，并确定 RA 和 ESRD 患者骨折的危险因素。
使用美国肾脏数据系统（USRDS）进行回顾性队列研究，以确定 2005-2008 年开始透析的有和无 RA 病史的 ESRD 成年人。国际疾病分类，第 9 版（ICD-9）代码用于确定透析开始后的骨折。比较有和无 RA 患者的新发骨折风险。对 RA 和 ESRD 患者的骨折潜在危险因素进行分析。
在 ESRD 患者中，RA 患者发生髋部或其他股骨骨折的风险增加 28%。皮质类固醇的使用是 RA 和 ESRD 患者骨折的一个潜在可改变的危险因素。
在 754 名 ESRD 合并 RA 的患者中，有 126 名（17%）发生了任何部位的骨折。在多变量调整的最终模型中，在 ESRD 患者中，RA 是髋部/股骨骨折的独立危险因素（RR 1.28，95%CI 1.01-1.64）。在 RA 和 ESRD 患者中，在最终模型中，只有皮质类固醇的使用是所有新发骨折（RR 2.00，95%CI 1.40-2.87）和髋部/股骨骨折（RR 1.97，95%CI 1.24-3.11）的显著危险因素。体重指数较高的患者发生髋部/股骨骨折的相对风险较低（RR 0.95，95%CI 0.91-0.99）。
