Jones C Allyson, Guy Pierre, Xie Hui, Sayre Eric C, Zhao Kai, Lacaille Diane
University of Alberta, Edmonton, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
University of British Columbia, Vancouver, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2025 May;77(5):604-613. doi: 10.1002/acr.25466. Epub 2024 Dec 22.
Osteoporosis, a known complication of rheumatoid arthritis (RA), increases the risk of hip fracture, which is associated with high morbidity and mortality. Fracture risk estimates in patients with RA treated with contemporary treatment strategies are lacking. The objectives were (1) estimate age-specific and sex-specific incidence rates and compare the risk of hip fractures in RA relative to age-matched and sex-matched general population controls, and (2) compare the risk of all-cause mortality in RA and general population controls after hip fracture.
A longitudinal study of a population-based incident cohort of patients with RA diagnosed between 1997 and 2009, followed until 2014, with age-matched and sex-matched controls from the general population of British Columbia, using administrative health data. Hip fracture outcomes (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 820.0 or 820.2; ICD-10-Canada code S72.0 to S72.2) and mortality at predefined intervals after fracture (in hospital, 90 days, 1-year, 5-year) were identified. Hip fracture incidence rates for RA and controls, and incidence rate ratios (IRRs), were calculated. Cox proportional hazards models compared hip fracture and mortality risk in RA versus controls; logistic regression compared in-hospital mortality risk.
Overall, 1,314 hip fractures over 360,521 person-years were identified in 37,616 individuals with RA and 2,083 over 732,249 person-years in 75,213 controls, yielding a 28% greater fracture risk in RA (IRR 1.28 [95% confidence interval 1.20-1.37]). Mean age at time of fracture was slightly younger for RA than controls (79.6 ± 10.8 vs 81.6 ± 9.3 years). Postfracture mortality risk at one-year and five-years did not differ between RA and general population controls. Results were similar in a sensitivity analysis including only individuals with RA who received disease-modifying antirheumatic drugs.
People with RA had a greater risk of hip fractures, but no greater risk of mortality post fracture, than the general population. The relative risk of hip fractures observed was not as high as previously reported, likely reflecting better treatment of inflammation and management of osteoporosis and its risk factors.
骨质疏松症是类风湿关节炎（RA）的一种已知并发症，会增加髋部骨折风险，而髋部骨折与高发病率和高死亡率相关。目前缺乏采用当代治疗策略治疗的RA患者骨折风险评估。本研究目的为：（1）估计特定年龄和性别的发病率，并比较RA患者与年龄和性别匹配的普通人群对照的髋部骨折风险；（2）比较RA患者和普通人群对照在髋部骨折后的全因死亡风险。
一项基于人群的纵向队列研究，纳入1997年至2009年间诊断为RA的患者，随访至2014年，并使用行政卫生数据从不列颠哥伦比亚省普通人群中选取年龄和性别匹配的对照。确定髋部骨折结局（国际疾病分类第九版临床修订本[ICD-9-CM]编码820.0或820.2；ICD-10加拿大编码S72.0至S72.2）以及骨折后预定时间间隔（住院、90天、1年、5年）的死亡率。计算RA患者和对照的髋部骨折发病率以及发病率比（IRR）。采用Cox比例风险模型比较RA患者与对照的髋部骨折和死亡风险；采用逻辑回归比较住院死亡风险。
总体而言，37616例RA患者在360521人年中发生1314例髋部骨折，75213例对照在732249人年中发生2083例髋部骨折，RA患者骨折风险高28%（IRR 1.28[95%置信区间1.20 - 1.37]）。RA患者骨折时的平均年龄略低于对照（79.6±10.8岁对81.6±9.3岁）。RA患者和普通人群对照在骨折后1年和5年的死亡风险无差异。在仅纳入接受改善病情抗风湿药物治疗的RA患者的敏感性分析中，结果相似。
与普通人群相比，RA患者髋部骨折风险更高，但骨折后死亡风险无差异。观察到的髋部骨折相对风险不如先前报道的高，这可能反映了炎症治疗、骨质疏松症及其风险因素管理的改善。
