Background/Purpose: patients with Psoriatic Arthritis (PsA) in spite of having bone production as one of their characteristic features, very often have osteoporosis, but scarce data is available on fracture risk. Our objective was to compare incidence of osteoporotic fractures in PsA patients diagnosed after year 2000 with matched controls from a university hospital-based health management organization (HMO).

Methods: Consecutive PsA patients diagnosed after year 2000, from the HMO, were matched (age and sex) with controls (1:2). The follow-up period began at the first medical claim at the HMO. Subjects were then followed until they voluntarily left the HMO, a fracture occurred, the end of study (May 1st 2018), or death. Electronic medical records were reviewed and demographic, clinical and treatment data were collected. Incidence rates per 1000 persons-years (PY) of distinct types of fractures after index dates were calculated and compared between groups. A multivariate cox regression analysis was performed to investigate determinants of fractures.

Results: 92 PsA patients were included. Patients characteristics are shown in table 1. 92 PsA patients contributed with 788.2 PY of follow up, and 184 controls contributed 1718.4 PY. Media age at psoriasis and PsA diagnosis was 34.5 years (SD 19.3) and 49.1 years (SD 17.7) respectively. 8.7 % (95% CI 4.4-16.5) of PsA patients had axial involvement. 84.6 % (95% CI 75.5-90.8) of PsA patients were treated with conventional DMARDs and 29.7% (95% CI 21.1-40.0) received biologic treatment. Topical corticosteroids were used by 60.9% (95% CI 50.5-70.4) of PsA patients and 22.8% (95% CI 15.3-32.6) received oral corticosteroids. No difference was found in the overall fracture incidence rate per 1000 PY between PsA and controls (10.2, 95% CI 5.1-19.3, vs 8.7, 95% CI 5.2-13.9, p 0.36). Vertebral fractures were more frequent in PsA patients with an incidence rate of 10.2 per 1000 persons-years (95% CI 5.1-19.3) versus 4.6 per 1000 persons-years in the control group (95% CI 2.4-9.2), but it did not reach statistical significance (p=0.06). In the Cox regression analysis, after adjusting for biphosphonate use, only age (HR 1.10, 1.05-1.16, p < 0.001) and a female sex (HR 3.94, 1.11-13.91, p =0.03) were associated with fractures while PsA diagnosis and use of corticosteroids were not.

Conclusion: in this cohort of PsA patients diagnosed after year 2000, no overall increased risk of fractures was found in comparison with matched controls. This may be due to a rational use of corticosteroids.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fragility-fractures-in-psoriatic-arthritis-patients-a-matched-control-study/