Background/Purpose: Rheumatoid arthritis (RA) and End Stage Renal Disease (ESRD) are independent risk factors for osteoporotic fractures. Approximately one percent of persons with ESRD have RA. To our knowledge, there are no reports of whether persons with RA and ESRD are at greater risk for osteoporotic fracture than the general ESRD population. The purpose of this study was to determine whether RA is a risk factor for fractures in patients with ESRD and to characterize risk factors for these fractures.

Methods: A cohort study of ESRD patients with and without RA within the United States Renal Data System (USRDS) from 2006-2008 followed through 2011. The International Classification of Diseases, ninth revision (ICD-9) codes 714.0, 714.1, 714.2, 714.81 were utilized to identify those with a history of RA using the hospital claims data occurring on or before their dialysis start date. Fractures were identified using ICD-9 codes for fracture of the vertebrae (805.xx-806xx), upper (812.xx-817.xx), hip (820.xx-822.xx), lower extremity (823.xx-825.xx), pathological fracture (733.0, 733.1, 733.11, 733.12, 733.13, 733.14, 733.15, 733.16, 733.19) and stress fracture (733.93-733.98).

Results: There were 10,706 persons with ESRD and no history of RA in the analysis data set of whom 1570 (14.5%) had an incident fracture and 1040 persons with RA of whom 14.5% (266 persons) had an incident fracture. In multivariable adjusted models including age, gender, race, ethnicity, BMI, type of dialysis, smoking, alcohol use, vitamin D deficiency, hyperparathyroidism, secondary osteoporosis (of renal origin), hypogonadism, hyperthyroidism and prevalent fractures (within 5 years prior to start of dialysis), RA was a significant risk factor for any incident fracture (RR 1.83 (95% CI 1.59-2.11)) and incident hip fractures (RR 1.86 (95% CI 1.50-2.30)). Prevalent fractures (in the five years prior to initiation of dialysis) were significantly associated with all and hip fractures (p<0.01) and Black and Other race and BMI were significantly inversely associated with all and hip fractures.

Conclusion: In patients with RA and ESRD, the risk of osteoporotic fractures including hip and spine fractures is almost twofold greater than that of the general ESRD population. Risk factors for fractures in patients with RA and ESRD are similar to that of the general population. Attention to osteoporosis prevention is important in patients with RA and renal disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-osteoporotic-fractures-in-patients-with-rheumatoid-arthritis-and-end-stage-renal-disease-findings-from-the-usrds-database/