Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct;40(10):1669-76.
doi: 10.3899/jrheum.121493. Epub 2013 Aug 15.

Are young women and men with rheumatoid arthritis at risk for fragility fractures? A population-based study

Shreyasee Amin  1 , Sherine E Gabriel, Sara J Achenbach, Elizabeth J Atkinson, L Joseph Melton 3rd
Affiliations

Are young women and men with rheumatoid arthritis at risk for fragility fractures? A population-based study

Shreyasee Amin et al. J Rheumatol. 2013 Oct.

Abstract

Objective: Older women and men with rheumatoid arthritis (RA) are at increased risk for fractures, but limited information is available on fracture risk in younger individuals with RA and whether such risk occurs early in the disease onset or only when older. We determined the risk for fractures in both young and older women and men following RA diagnosis.

Methods: We studied a population-based inception cohort with RA from Olmsted County, Minnesota, USA. We identified 822 women and 349 men diagnosed with RA between 1955 and 2007 (308 women and 110 men diagnosed before age 50) and an equal number of paired non-RA subjects, matched by sex and birth year. Incident fractures were collected through review of complete (inpatient and outpatient) medical records available through the linkage system of the Rochester Epidemiology Project.

Results: The hazard ratio (HR; 95% CI) for a non-pathologic fracture occurring from no more than moderate trauma was 1.63 (1.36-1.96) for women and 1.40 (1.02-1.93) for men with RA. Findings were consistent for women and men diagnosed with RA at age ≥ 50 years [HR, 1.43 (1.16-1.77) and 1.34 (0.92-1.94), respectively], or at age < 50 years [HR, 2.34 (1.61-3.42) and 1.74 (0.91-3.30), respectively]. However, young women, but not young men, with RA were at increased fracture risk even before age 50 years (HR, 1.95 [1.08-3.51] and 0.82 [0.28-2.45], respectively).

Conclusion: Young men with RA are at increased risk for fractures only when older, whereas young women with RA have an elevated fracture risk even while still young.

Keywords: BONE FRACTURES; EPIDEMIOLOGY; OSTEOPOROSIS; RHEUMATOID ARTHRITIS.

PubMed Disclaimer

Conflict of interest statement

DISCLOSURES

All authors have no conflicts of interest with respect to this work. Dr. Amin served on a scientific advisory board for Merck & Co.

Figures

Figure 1
Figure 1
Kaplan-Meier curves for the cumulative incidence of a fragility fracture, accounting for the competing risk of death, in all women with RA and their matched non-RA pair and in all men with RA and their matched non-RA pair, following either RA diagnosis or equivalent index date for non-RA subjects. Cumulative incidence of fragility fractures at 20 years is estimated at 49% vs. 35%, respectively, for RA and non-RA women and 40% vs. 27%, respectively, for RA and non-RA men.
Figure 2
Figure 2
Kaplan-Meier curves for the cumulative incidence of a fragility fracture, accounting for the competing risk of death, following either RA diagnosis or equivalent index date for non-RA subjects each for women and men of different age groups (age ≥ 50 years and age < 50 years at RA diagnosis/index date). Cumulative incidence for a fragility fracture at 20 years in RA and non-RA subjects, respectively, was: 56% vs. 48% for women age ≥ 50 years; 38% vs. 17% for women age < 50 years; 50% vs. 35% for men age ≥ 50 years; and 28% vs. 16% in men age < 50 years.
See this image and copyright information in PMC

References

    1. Sinigaglia L, Varenna M, Girasole G, Bianchi G. Epidemiology of osteoporosis in rheumatic diseases. Rheumatic Diseases Clinics of North America. 2006;32(4):631–658. - PubMed
    1. Amin S. Bone loss and fractures in rheumatoid arthritis. In: Maricic MJ, Gluck O, editors. Bone Disease in Rheumatology. Lippincott, Williams & Wilkins; Philadelphia: 2005. pp. 73–78.
    1. Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N. Assessment of fracture risk. Osteoporosis International. 2005;16(6):581–589. - PubMed
    1. Wright NC, Lisse JR, Walitt BT, Eaton CB, Chen Z, Women’s Health Initiative I. Arthritis increases the risk for fractures–results from the Women’s Health Initiative. Journal of Rheumatology. 2011;38(8):1680–1688. - PMC - PubMed
    1. Vis M, Haavardsholm EA, Boyesen P, Haugeberg G, Uhlig T, Hoff M, Woolf A, Dijkmans B, Lems W, Kvien TK. High incidence of vertebral and non-vertebral fractures in the OSTRA cohort study: a 5-year follow-up study in postmenopausal women with rheumatoid arthritis. Osteoporosis International. 2011;22(9):2413–2419. - PMC - PubMed

LinkOut - more resources