Kishimoto Yuji, Kato Yoshihiro, Uemura Manami, Kuranobu Koji
Department of Rheumatology, Tottori Red Cross Hospital, 117 Shotoku-cho, Tottori-shi, Tottori, 680-8517, Japan.
Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori, 680-8517, Japan.
BMC Rheumatol. 2022 Feb 28;6(1):8. doi: 10.1186/s41927-021-00243-x.
Although many studies have reported the predictors of fractures in patients with rheumatoid arthritis (RA) who are not receiving anti-osteoporotic treatments or who are receiving unspecified treatments, studies focusing on the predictors of fracture in patients with RA who are currently being treated with oral bisphosphonates (BP) are quite scarce. This study aims to investigate the incidence and predictors of fragility fracture in postmenopausal patients with RA receiving oral BP.
This retrospective longitudinal observational study comprised 98 postmenopausal RA patients receiving oral BP for a minimum of 6 months between April 2015 and December 2020. The cumulative incidence of fragility fractures including vertebral and nonvertebral fractures was investigated using the Kaplan-Meier method. Cox proportional hazards analysis was used to analyze baseline predictors of future fragility fractures. To determine a cutoff value of continuous predictors, the receiver-operating characteristic curve was applied.
Twenty patients developed fractures during the study period, with a cumulative incidence of 6.1% at 12 months, 10.5% at a median follow-up of 28 months, and 14.4% at 36 months. Multivariable Cox hazards analysis showed a history of prior vertebral fracture (hazard ratio [HR] 6.26, 95% confidence interval [CI] 1.99‒19.68, P = 0.001) and dose of methotrexate (HR 0.87, 95% CI 0.76‒0.99, P = 0.041) to be independent predictors. The cutoff value for methotrexate dose was 4 mg/week.
We found a cumulative incidence of any fractures of 10.5% at 28 months in patients with RA currently being treated with oral BP. A history of prior vertebral fractures and methotrexate dose were positive and negative predictors for fractures, respectively. Practitioners should consider selecting another anti-osteoporotic drug in patients with RA who remain at risk despite receiving oral BP.
尽管许多研究报告了未接受抗骨质疏松治疗或接受未明确治疗的类风湿关节炎（RA）患者骨折的预测因素，但关注目前正在接受口服双膦酸盐（BP）治疗的RA患者骨折预测因素的研究相当匮乏。本研究旨在调查接受口服BP的绝经后RA患者脆性骨折的发生率及预测因素。
这项回顾性纵向观察性研究纳入了98例在2015年4月至2020年12月期间接受口服BP至少6个月的绝经后RA患者。采用Kaplan-Meier法调查包括椎体骨折和非椎体骨折在内的脆性骨折的累积发生率。采用Cox比例风险分析来分析未来脆性骨折的基线预测因素。为确定连续预测因素的截断值，应用了受试者操作特征曲线。
20例患者在研究期间发生骨折，12个月时累积发生率为6.1%，中位随访28个月时为10.5%，36个月时为14.4%。多变量Cox风险分析显示，既往椎体骨折史（风险比[HR]6.26，95%置信区间[CI]1.99‒19.68，P = 0.001）和甲氨蝶呤剂量（HR 0.87，95%CI 0.76‒0.99，P = 0.041）是独立预测因素。甲氨蝶呤剂量的截断值为4mg/周。
我们发现目前接受口服BP治疗的RA患者在28个月时任何骨折的累积发生率为10.5%。既往椎体骨折史和甲氨蝶呤剂量分别是骨折的阳性和阴性预测因素。对于尽管接受口服BP仍有骨折风险的RA患者，医生应考虑选择其他抗骨质疏松药物。
