Background/Purpose: Polymyalgia rheumatica (PMR) is an inflammatory disease associated with older age and long term use of glucocorticoids. As such a high incidence of osteoporosis and osteoporosis related fractures is expected. There is scarce information on incidence of osteoporotic-fractures in PMR in developing countries.The objective of this study was to identify the incidence rate and risk factors for osteoporotic-fractures in PMR patients.

Methods:  we retrospectively reviewed electronic medical records (EMR) of patients registered in a large University hospital between years 2000-2015 with the diagnosis of PMR. Patients fulfilling ACR PMR 2012 criteria or with a clinical diagnose made by a rheumatologist were included. Patients with previous history of fractures, or with traumatic fractures were excluded. The major osteoporotic fractures (hip, wrist, and clinical spine) retrieved from the EMR, during the follow up period were taken as the endpoint event. Global, and sex-specific incidence rate with their 95% CI was calculated. A Cox proportional hazards models was fitted to analyze variables associated with suffering a fracture, including age, sex, smoking, hypertension, obesity, time on steroids, and steroids initial dose.

Results:  998 patients contributing a total of 4283 patient-years were included. Patient characteristics are shown in the table. During follow up 93 fractures were observed, for an overall incident rate (cases per 1000 patient-years) of 21.7 (95% CI: 17.7-26.6), 26.3 (95% CI: 21.2-32.5) for women, and 8.3 (95% CI: 4.3-15.9) for men. Forty-three incident osteoporotic hip fractures were observed for an overall incident rate of 10 (95% CI: 7.4-13.5) per/1000 patient-years, 12.5 (95% CI: 9.2-17) for women, and 2.8 (95% CI: 0.9-8.5) for men. The incident rate (cases per 1000 patient-years) for wrist and clinical vertebral fractures were: overall: 7 (95% CI: 4.9-10); 9 (95% CI: 6.3-13) for women, and 0.9 (95% CI: 0.13-6.5) for men; and 4.7 (95% CI: 3-7.2), 4.7 (95% CI: 2.8-7.8) for women, and 4.6 (95% CI: 1.9-11) for men, respectively. In the univariate analysis patients with fractures were significantly more females, of older age, and received steroids for a longer period (table). In the multivariate Cox proportional hazards model, the only variables associated with osteoporotic fractures were female sex (HR: 2.7 (95% CI: 1.6-4.6), and older age at diagnosis (HR: 1.1 (95% CI: 1-1.1).

Conclusion:  There was a high incidence rate of major osteoporotic fractures among patients with PMR. Females and patients with older age were at higher risk. This risk should be taken into account when treating this disease. Table 1 Patients characteristics

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-of-osteoporotic-mayor-fractures-in-a-cohort-of-patients-with-polymyalgia-rheumatica/