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 |
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 January 27, 2020.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/in-the-21st-century-is-still-rheumatoid-arthritis-a-risk-factor-for-osteoporotic-fractures/