Department of Rheumatology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain.
Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
Bone. 2023 Mar;168:116654. doi: 10.1016/j.bone.2022.116654. Epub 2022 Dec 28.
To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture.
Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients.
Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37).
Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.
评估类风湿关节炎（RA）绝经后妇女临床脆弱性骨折的发生率，并分析骨折的危险因素。
比较 330 例绝经后 RA 妇女和 660 例年龄匹配的西班牙绝经后对照人群的临床脆性骨折发生率。记录前五年的临床骨折情况。我们分析了两个人群中与骨折相关的危险因素以及 RA 患者与疾病相关的变量。
RA 患者的中位年龄为 64 岁；中位 RA 病程为 8 年。69%的患者处于缓解或低活动期。85%的患者接受了糖皮质激素（GCs）治疗；85%接受了甲氨蝶呤治疗；40%接受了≥1 种生物 DMARD 治疗。54 例患者和 47 例对照者有≥1 处主要骨质疏松性骨折（MOF）。患者的 MOF 发生率为每 100 患者年 3.55 例，对照组为 0.72 例（HR：2.6）。RA 患者 MOF 的危险因素包括年龄、既往骨折、父母髋部骨折、绝经后年数、BMD、侵蚀、疾病活动度和残疾以及 GCs 的累积剂量。RA 患者既往骨折是 MOF 的一个强烈危险因素（HR：10.37）。
每 100 例西班牙绝经后 RA 妇女中，每年有 3-4 例发生 MOF。这比一般人群高出两倍多。既往骨折对新骨折构成高风险。其他骨折的经典危险因素，如 RA 疾病活动度和残疾以及 GCs 的累积剂量，与骨折的发生有关。
