类风湿性关节炎、皮质类固醇疗法与髋部骨折
Rheumatoid arthritis, corticosteroid therapy and hip fracture.
作者信息
Cooper C, Coupland C, Mitchell M
机构信息
MRC Environmental Epidemiology Unit, Southampton General Hospital, United Kingdom.
出版信息
Ann Rheum Dis. 1995 Jan;54(1):49-52. doi: 10.1136/ard.54.1.49.
Abstract
OBJECTIVE
To identify the risk of hip fracture in patients with rheumatoid arthritis and those taking corticosteroids.
METHODS
In a population based case-control study, we compared 300 consecutive patients with hip fracture aged 50 years and over from a defined district and 600 age and sex matched community controls.
RESULTS
The risk of hip fracture was increased in patients with rheumatoid arthritis (odds ratio (OR) 2.1; 95% confidence interval (CI) 1.0 to 4.7) and those receiving corticosteroids (OR 2.7; 95% CI 1.2 to 5.8). The risk attributable to rheumatoid arthritis was markedly reduced by adjusting for functional impairment, while that for steroid use remained after adjusting for body mass index, smoking, alcohol, and functional status.
CONCLUSIONS
Hip fracture risk is approximately doubled amongst patients with rheumatoid arthritis and among those taking steroids. These risk increases are, to some extent, independent of each other. In rheumatoid arthritis, the risk was most closely associated with functional impairment, whereas steroid use did not appear to be confounded by this variable.
摘要
目的
确定类风湿关节炎患者及服用皮质类固醇药物患者发生髋部骨折的风险。
方法
在一项基于人群的病例对照研究中，我们比较了来自特定地区的300例年龄在50岁及以上的连续髋部骨折患者和600例年龄及性别匹配的社区对照者。
结果
类风湿关节炎患者（比值比（OR）2.1；95%置信区间（CI）1.0至4.7）及接受皮质类固醇药物治疗的患者（OR 2.7；95% CI 1.2至5.8）发生髋部骨折的风险增加。通过调整功能障碍因素，类风湿关节炎所致的风险显著降低，而在调整体重指数、吸烟、饮酒及功能状态后，使用类固醇药物所致的风险依然存在。
结论
类风湿关节炎患者及服用类固醇药物的患者发生髋部骨折的风险大约增加一倍。这些风险增加在一定程度上相互独立。在类风湿关节炎中，风险与功能障碍最为密切相关，而使用类固醇药物似乎不受该变量的影响。
相似文献
1
Rheumatoid arthritis, corticosteroid therapy and hip fracture.类风湿性关节炎、皮质类固醇疗法与髋部骨折
Ann Rheum Dis. 1995 Jan;54(1):49-52. doi: 10.1136/ard.54.1.49.
2
[Prevalence of risk factors for fragility fracture in men aged 40 to 90 years of a Spanish basic Rural Health Area].[西班牙一个基本农村卫生区40至90岁男性脆性骨折风险因素的患病率]
Rev Esp Salud Publica. 2011 Oct;85(5):491-8. doi: 10.1590/S1135-57272011000500008.
3
Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis.类风湿关节炎患者骨折长期风险的临床评估
Arthritis Rheum. 2006 Oct;54(10):3104-12. doi: 10.1002/art.22117.
4
Cigarette smoking, alcohol consumption, and risk of hip fracture in women.女性吸烟、饮酒与髋部骨折风险
Arch Intern Med. 2001 Apr 9;161(7):983-8. doi: 10.1001/archinte.161.7.983.
5
Risk factors associated with the occurrence of hip fracture in Japanese patients with rheumatoid arthritis: a prospective observational cohort study.与日本类风湿关节炎患者髋部骨折发生相关的风险因素：一项前瞻性观察性队列研究。
Osteoporos Int. 2013 Apr;24(4):1257-65. doi: 10.1007/s00198-012-2080-0. Epub 2012 Jul 17.
6
Predicting the 10-year risk of hip and major osteoporotic fracture in rheumatoid arthritis and in the general population: an independent validation and update of UK FRAX without bone mineral density.预测类风湿关节炎患者及普通人群髋部和主要骨质疏松性骨折的10年风险：UK FRAX在无骨密度情况下的独立验证与更新
Ann Rheum Dis. 2016 Dec;75(12):2095-2100. doi: 10.1136/annrheumdis-2015-208958. Epub 2016 Mar 16.
7
Rheumatoid arthritis patients with hip fracture: a nationwide study.类风湿关节炎患者髋部骨折：一项全国性研究。
Osteoporos Int. 2015 Feb;26(2):811-7. doi: 10.1007/s00198-014-2968-y. Epub 2014 Nov 20.
8
Fractures in patients with rheumatoid arthritis and end-stage renal disease.类风湿关节炎和终末期肾病患者的骨折。
Arch Osteoporos. 2020 Sep 18;15(1):146. doi: 10.1007/s11657-020-00815-3.
9
Incidence of and Risk of Mortality After Hip Fractures in Rheumatoid Arthritis Relative to the General Population.类风湿关节炎患者髋部骨折后的发病率及死亡风险与普通人群的比较
Arthritis Care Res (Hoboken). 2025 May;77(5):604-613. doi: 10.1002/acr.25466. Epub 2024 Dec 22.
10
Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study.非典型股骨骨折的发生率、风险因素和骨折愈合：一项多中心病例对照研究。
Osteoporos Int. 2018 Nov;29(11):2427-2435. doi: 10.1007/s00198-018-4640-4. Epub 2018 Jul 23.
引用本文的文献
1
Peptide targeting improves the delivery and therapeutic index of glucocorticoids to treat rheumatoid arthritis.肽靶向提高糖皮质激素治疗类风湿关节炎的递送和治疗指数。
J Control Release. 2024 Apr;368:329-343. doi: 10.1016/j.jconrel.2024.02.040. Epub 2024 Mar 5.
2
Effect of Hypertension on Bone Mineral Density of Patients with Rheumatoid Arthritis.高血压对类风湿关节炎患者骨密度的影响。
Mediterr J Rheumatol. 2023 Sep 12;34(4):479-485. doi: 10.31138/mjr.120923.eoh. eCollection 2023 Dec.
3
Effects of (mill.) urb. bulb extract on mice glucocorticoid-induced osteoporosis models.（百万）城市鳞茎提取物对小鼠糖皮质激素诱导的骨质疏松模型的影响。
J Public Health Afr. 2023 Mar 16;14(Suppl 1):2507. doi: 10.4081/jphia.2023.2507. eCollection 2023 Mar 30.
4
Validating the Fracture Risk Assessment Tool Score in a US Population-Based Study of Patients With Rheumatoid Arthritis.验证 Fracture Risk Assessment Tool 评分在美国类风湿关节炎患者人群研究中的有效性。
J Rheumatol. 2023 Oct;50(10):1279-1286. doi: 10.3899/jrheum.2022-1293. Epub 2023 Jul 1.
5
Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021.执行摘要：意大利 2021 年脆性骨折的诊断、风险分层和护理连续性指南。
Front Endocrinol (Lausanne). 2023 Apr 18;14:1137671. doi: 10.3389/fendo.2023.1137671. eCollection 2023.
6
Personalized Therapeutic Strategies in the Management of Osteoporosis in Patients with Autoantibody-Positive Rheumatoid Arthritis.自身抗体阳性类风湿关节炎患者骨质疏松症管理中的个性化治疗策略
J Clin Med. 2022 Apr 22;11(9):2341. doi: 10.3390/jcm11092341.
7
..
Rheumatol Adv Pract. 2021 Nov 16;6(2):rkab089. doi: 10.1093/rap/rkab089. eCollection 2022.
8
A Comparison of Demographics, Disease Activity, Disability, and Treatment Among Rheumatoid Arthritis Patients with and without Osteoporosis.类风湿关节炎合并和不合并骨质疏松症患者的人口统计学、疾病活动度、残疾情况及治疗比较
Open Access Rheumatol. 2021 Sep 14;13:275-283. doi: 10.2147/OARRR.S318810. eCollection 2021.
9
The Emerging Roles of Endocrine Hormones in Different Arthritic Disorders.内分泌激素在不同关节炎性疾病中的新作用。
Front Endocrinol (Lausanne). 2021 May 21;12:620920. doi: 10.3389/fendo.2021.620920. eCollection 2021.
10
Effects of changes in regular physical activity status on hip fracture: A nationwide population-based cohort study in Korea.规律体力活动状态变化对髋部骨折的影响：韩国一项全国范围内基于人群的队列研究。
PLoS One. 2021 Apr 8;16(4):e0249819. doi: 10.1371/journal.pone.0249819. eCollection 2021.
本文引用的文献
1
STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION.老年人疾病研究。日常生活活动能力指数：生物和心理社会功能的标准化测量方法。
JAMA. 1963 Sep 21;185:914-9. doi: 10.1001/jama.1963.03060120024016.
2
Vertebral fractures resulting from prolonged cortisone and corticotropin therapy.长期使用可的松和促肾上腺皮质激素治疗导致的椎体骨折。
J Am Med Assoc. 1954 Oct 2;156(5):467-9. doi: 10.1001/jama.1954.02950050007002.
3
Risk of vertebral fracture in women with rheumatoid arthritis.类风湿关节炎女性患者椎体骨折的风险
BMJ. 1993 Feb 27;306(6877):558. doi: 10.1136/bmj.306.6877.558.
4
Bone mineral density of the hip and of the anteroposterior and lateral dimensions of the spine in men with rheumatoid arthritis. Effects of low-dose corticosteroids.类风湿性关节炎男性患者的髋部骨矿物质密度以及脊柱前后径和侧径的骨矿物质密度。低剂量皮质类固醇的影响。
Arthritis Rheum. 1993 Feb;36(2):222-8. doi: 10.1002/art.1780360213.
5
Fractures in rheumatoid arthritis: an evaluation of associated risk factors.类风湿关节炎中的骨折：相关危险因素评估
J Rheumatol. 1993 Oct;20(10):1666-9.
6
The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women.类风湿关节炎及类固醇疗法对绝经后女性骨密度的影响。
Arthritis Rheum. 1993 Nov;36(11):1510-6. doi: 10.1002/art.1780361105.
7
Steroid-induced fractures and bone loss in patients with asthma.哮喘患者的类固醇诱导性骨折和骨质流失
N Engl J Med. 1983 Aug 4;309(5):265-8. doi: 10.1056/NEJM198308043090502.
8
Total body calcium in rheumatoid arthritis: effects of disease activity and corticosteroid treatment.类风湿关节炎患者的全身钙含量：疾病活动度及皮质类固醇治疗的影响
Br Med J (Clin Res Ed). 1982 Jul 31;285(6338):330-2. doi: 10.1136/bmj.285.6338.330.
9
Relationship between local and total bone mineral in patients with rheumatoid arthritis and normal subjects.类风湿关节炎患者与正常受试者局部骨矿物质与总骨矿物质的关系。
Clin Rheumatol. 1983 Sep;2(3):265-71. doi: 10.1007/BF02041401.
10
Fractures after rheumatoid arthritis. A population-based study.类风湿关节炎后的骨折。一项基于人群的研究。
Arthritis Rheum. 1984 Dec;27(12):1353-61. doi: 10.1002/art.1780271205.
Zotero 插件