Background/Purpose: Osteoporotic fractures represent one of the serious extra-articular manifestations of rheumatoid arthritis (RA). The aim of this study was to investigate whether fracture incidence differs between patients with early RA diagnosed in the 1990s and the 2000s, and compared to the general population.

Methods: The RA-patients were recruited from the BARFOT (Better Anti-Rheumatic FarmacO Therapy) cohort, which is a Swedish multicentre observational study of patients with early RA. All patients fulfilled the 1987 American College of Rheumatology classification criteria and were included between 1992 and 2006. For each patient four reference subjects matched for sex, age and residential area were randomly selected from the general population using data from the Swedish Central Statistics Office. Cases with new osteoporotic fractures were identified through the Swedish National Inpatients Register, the Swedish Outpatients Register and the Swedish Cause of Death Register until December 2013. Analysis were performed for the total study population and also stratified by inclusion period; 1992-1999 and 2000-2006.

Results: During a mean (SD) follow-up period of 14 (3.9) years 617 of 2751 (16.8%) patients with RA and 1901 of 11004 (13.6%) of controls had an osteoporotic fracture (p <0.001). 18.2% of RA-patients included 1992-1999 (n=314) experienced a fracture (controls 14.8%; p=0,001) and 15.9% of RA-patients included 2000-2006 (n=303) experienced a fracture (controls 12.4%; p=0.002). Compared to the controls the risk HR (95%CI) of sustaining any clinical fracture in the whole RA-group was 1.33 (1.18, 1.50) (p<0.001). The risk was increased for both inclusion periods; 1990s 1.28 (1.09, 1.52) (p=0.003) and 2000s 1.41 (1.17, 1.70) (p<0.001), although the patients included later more often started treatment with DMARDs at the first visits, inclusion; 88% vs 65% (p<0.001) and at 3 months follow-up; 90% vs 72% (p<0.001).

Conclusion: Our study showed an increased risk of osteoporotic fractures in patients with early RA compared with population based reference subjects matched for sex and age and residential area. This was also shown when stratified by the 1990s and the 2000s.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-fracture-risk-in-patients-with-early-rheumatoid-arthritis-in-the-1990s-as-well-as-in-the-2000s-a-prospective-general-population-matched-cohort-study/