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Abstract Number: 2307

In the 21st Century: Is Still Rheumatoid Arthritis a Risk Factor for Osteoporotic Fractures?

Florencia Pierini1, Luciano Fernando Lo Giudice2, Marina Scolnik3, Javier Rosa2, Valeria Scaglioni3 and Enrique R Soriano1, 1Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, CABA, Argentina, 2Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Capital Federal, Argentina, 3Rheumatology Unit, Internal Medicine Service. Hospital Italiano Buenos Aires. Argentina, Buenos Aires, Argentina

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: fractures, Osteoporosis and rheumatoid arthritis (RA)

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Session Information

Date: Tuesday, October 23, 2018

Session Title: Osteoporosis and Metabolic Bone Disease – Basic and Clinical Science Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Rheumatoid Arthritis (RA) has been considered an independent osteoporotic risk factor. Nowadays, RA patients have a better disease control and corticosteroid use is less intense. Our objective was to compare incidence of osteoporotic fractures in RA patients diagnosed after year 2000 with matched controls from a university hospital-based health management organization (HMO).

Methods: Consecutive RA patients (n=100) diagnosed after year 2000 (all fulfilling criteria ACR/EULAR 2010 of AR), from the HMO, were matched (age and sex) with controls (1:2). The follow-up period began at the index date, defined as the date of RA diagnosis for RA patients and the date of the first medical claim at the HMO for the non-RA patients. 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 identify factors associated with fractures.

Results: Patients characteristics are shown in table. RA patients were 97.9% (CI 92.0-99.5) seropositive (Rheumatoid Factor and/or ACPA) and were treated with conventional DMARDs in 94% (CI 87.1-97.3) and biologic DMARDs in 20 % (CI 13.2-29.1). 69% (CI 59.2-77.3) of RA patients used corticosteroids, but only 5% (CI 2.1-11.5) have ever used prednisone > 20 mg/d. No difference was found in the overall fracture incidence rate per 1000 PY between RA and controls (19.5, CI 12.7-28.6 vs 12.1, CI 7.7-18.7, p 0.07). In the Cox regression analysis, only age (HR 1.06, 1.02-1.11, p 0.006) and a prior fracture (HR 9.85, 2.97-32.64, p <0.001) were associated with fractures after the index date. Nor RA diagnosis (HR 0.86, CI 0.24-3.07, p 0.81) not a prolonged use (>3 months) of low dose corticosteroids (HR 1.57, CI 0.39-6.23, p 0.52)were associated with increased fracture risk. When analyzing each type of fracture, only vertebral fractures were more common in RA patients compared with controls (12.9 per 1000 PY, CI 8.9-25.8, versus 3.4, CI 1.4-8.1, p 0.01, respectively) but vertebral fractures were not associated to prolonged use of low dose corticosteroids (HR 3.43, CI 0.74-15.82, p 0.11).

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

RA patients

(n=100)

Controls (n=200)

p
Age at index date, years , media (SD) 62.1 (12.9) 62.4 (13.9) 0.87
Female, n (%, CI) 78 (78, 68.7-85.1) 156 (78, 71.7-83.2) 1
Follow up after index date, years, median (IQR) 9.5 (5.9-13.4) 5.9 (2.4-12.3) < 0.001
BMI <20, n (%, CI) 5 (5.3, 2.2-12.1) 1 (0.6, 0.1-4.3) 0.02
Ever Smoker, n (%, CI) 33 (33, 24.4-42.9) 31 (15.6, 11.1-21.3) 0.001
Menopause age, years, median (IQR) 47.8 (40.7-51) 48.4 (44.6-51.4) 0.27
Age at first Bone Mineral Density, years, median (RIQ) 62.7 (54.4-74.8) 67.0 (58.9-75.5) 0.09
Osteopenia at first BMD, n (%, CI) 21 (28.4, 19.2-39.8) 31 (35.6, 26.2-46.3) 0.33
Osteoporosis at first BMD, n (%, CI) 23 (31.3, 21.5-42.6) 22 (25, 16.9-35.2) 0.39
Osteoporosis at any Bone Mineral Density, n (%, CI) 27 (36.5, 26.2-48.1) 24 (27.3, 18.9-37.6) 0.21
Corticosteroid use, ever, n (%, CI) 69 (69.0, 59.2-77.3) 5 (2.5, 1.0-5.9) < 0.001
Prednisone use >= 20 mg/day, ever, n (%, CI) 5 (5.0, 2.1-11.5) 1 (0.5, 0.1-3.5) 0.01
Corticosteroid use >= 3 months, n (%, CI) 63 (63.0, 53.1-71.9) 4 (2.0, 0.7-5.2) < 0.001
Prior fracture, n (%, CI) 4 (4.0, 1.5-10.2) 3 (1.5, 0.5-4.6) 0.18
Any fracture, incidence rate per 1000 persons-years (CI) 19.5 (12.7-28.6) 12.1 (7.7-18.7) 0.07
Vertebral fracture, incidence rate per 1000 persons-years (CI) 12.9 (8.9-25.8) 3.4 (1.4-8.1) 0.01
Radius fracture, incidence rate per 1000 persons-years (CI) 7.4 (3.6-14.9) 4.7 (2.3-9.8) 0.21
Ulna fracture, incidence rate per 1000 persons-years (CI) 1.0 (0.1-7.1) 0.7 (0.1-4.7) 0.39
Humerus fracture, incidence rate per 1000 persons-years (CI) 1.0 (0.1-7.1) 4.1 (1.8-8.9) 0.09
Rib fracture, incidence rate per 1000 persons-years (CI) 0 0.7 (0.1-4.7) 0.30
Hip fracture, incidence rate per 1000 persons-years (CI) 6.3 (2.8-13.4) 3.4 (1.4-8.0) 0.16
Pelvis fracture, incidence rate per 1000 persons-years, CI 3.2 (0.9-9.4) 1.4 (0.3-5.3) 0.19

Disclosure: F. Pierini, None; L. F. Lo Giudice, None; M. Scolnik, None; J. Rosa, None; V. Scaglioni, None; E. R. Soriano, AbbVie, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer Inc, Roche, UCB, 2,AbbVie, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, 5,AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sandoz, UCB, 8.

To cite this abstract in AMA style:

Pierini F, Lo Giudice LF, Scolnik M, Rosa J, Scaglioni V, Soriano ER. In the 21st Century: Is Still Rheumatoid Arthritis a Risk Factor for Osteoporotic Fractures? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/in-the-21st-century-is-still-rheumatoid-arthritis-a-risk-factor-for-osteoporotic-fractures/. Accessed May 19, 2022.
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