Taylor-Williams Owen, Keen Helen, Preen David B, Nossent Johannes, Inderjeeth Charles A
Rheumatology Group, Medical School, University of Western Australia, Perth, Australia.
Royal Perth Hospital, Perth, Australia.
Osteoporos Int. 2025 Jan;36(1):113-121. doi: 10.1007/s00198-024-07311-1. Epub 2024 Nov 12.
Rheumatoid arthritis (RA) is a potentially devastating disorder associated with increased risk of fractures, but current studies do not completely evaluate the RA fracture risk profile. This study estimates fracture incidence by site of fracture and makes comparisons between RA and controls using the key variables gender, age, and comorbidities.
Rheumatoid arthritis RA is a potentially devastating osteoimmunological disorder, predisposing to osteoporosis (OP), fragility fracture (FF), and major osteoporotic fractures (MOF). As few studies incorporate statistical matching, comorbidity and non-MOF sites, we compared the incidence of first FF, MOF, and non-MOF in RA patients with a matched control cohort adjusting for comorbidities.
This longitudinal cohort study uses routinely collected administrative data from the West Australian Rheumatic Disease Epidemiological Registry (WARDER) between 1980 and 2015. RA patients, as defined using International Classification of Disease (ICD) codes, were compared to hospitalised patients free of rheumatic disease. Case-control matching adjusted for age, gender, and comorbidities (Charlson Comorbidity Index). Incidence rates (IR) per 1000 person years (PY) with 95% confidence intervals (CI) were compared by incidence rate ratios (IRR).
In RA patients from 2000 to 2010, the first fracture IR was 18.3 (15.7-21.2) for an IRR of 1.32 (1.10-1.60). Upper limb, lower limb, and axial IR were 5.56 (95% CI 4.18-7.26), 10.60 (95% CI 8.66-12.87), and 2.47 (95% CI 2.58-3.68) with IRR of 1.18 (95% CI 0.84-1.65), 1.44 (95% CI 1.19-1.86), and 1.01 (95% CI 0.61-1.63) respectively. The first fracture IR increased 6 years before first RA hospital record (RR 1.58, CI 1.05-2.39).
After age, gender, and comorbidity adjustment, RA is associated with a 32% higher incidence of first fracture, increased MOF, and a fracture incidence that is already increased before a first recorded RA diagnosis. This suggests a need for early attention to prevention of all fractures in RA patients.
类风湿关节炎（RA）是一种潜在的破坏性疾病，与骨折风险增加相关，但目前的研究并未全面评估RA的骨折风险情况。本研究按骨折部位估算骨折发生率，并使用性别、年龄和合并症等关键变量对RA患者和对照组进行比较。
类风湿关节炎（RA）是一种潜在的破坏性骨免疫疾病，易导致骨质疏松（OP）、脆性骨折（FF）和主要骨质疏松性骨折（MOF）。由于很少有研究纳入统计匹配、合并症和非MOF部位，我们比较了RA患者与匹配的对照组在调整合并症后的首次FF、MOF和非MOF的发生率。
这项纵向队列研究使用了1980年至2015年期间从西澳大利亚风湿病流行病学登记处（WARDER）常规收集的管理数据。使用国际疾病分类（ICD）编码定义的RA患者与无风湿性疾病的住院患者进行比较。病例对照匹配根据年龄、性别和合并症（Charlson合并症指数）进行调整。通过发病率比（IRR）比较每1000人年（PY）的发病率（IR）及其95%置信区间（CI）。
在2000年至2010年的RA患者中，首次骨折IR为18.3（15.7 - 21.2），IRR为1.32（1.10 - 1.60）。上肢、下肢和轴向骨折的IR分别为5.56（95% CI 4.18 - 7.26）、10.60（95% CI 8.66 - 12.87）和2.47（95% CI 2.58 - 3.68），IRR分别为1.18（95% CI 0.84 - 1.65）, 1.44（95% CI 1.19 - 1.86）和1.01（95% CI 0.61 - 1.63）。首次骨折IR在首次RA住院记录前6年增加（RR 1.58，CI 1.05 - 2.39）。
在调整年龄、性别和合并症后，RA与首次骨折发生率高32%、MOF增加以及在首次记录的RA诊断之前骨折发生率就已增加有关。这表明需要尽早关注RA患者所有骨折的预防。
