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. 2023 Mar:168:116654.
doi: 10.1016/j.bone.2022.116654. Epub 2022 Dec 28.

High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study

Carmen Gómez-Vaquero  1 , José Luis Hernández  2 , José Manuel Olmos  2 , Dacia Cerdà  3 , Cristina Hidalgo Calleja  4 , Juan Antonio Martínez López  5 , Luis Arboleya  6 , Francisco Javier Aguilar Del Rey  7 , Silvia Martinez Pardo  8 , Inmaculada Ros Vilamajó  9 , Xavier Surís Armangué  10 , Dolors Grados  11 , Chesús Beltrán Audera  12 , Evelyn Suero-Rosario  13 , Inmaculada Gómez Gracia  14 , Asunción Salmoral Chamizo  14 , Irene Martín-Esteve  13 , Helena Florez  15 , Antonio Naranjo  16 , Santos Castañeda  17 , Soledad Ojeda Bruno  16 , Sara García Carazo  18 , Alberto Garcia-Vadillo  17 , Laura López Vives  19 , Àngels Martínez-Ferrer  20 , Helena Borrell Paños  21 , Pilar Aguado Acín  18 , Raul Castellanos-Moreira  15 , Pau Satorra  22 , Cristian Tebé  23 , Núria Guañabens  15 ; OsteoResSer Working Group of the Spanish Society of Rheumatology
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Free article

High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study

Carmen Gómez-Vaquero et al. Bone. 2023 Mar.
Free article

Abstract

Objectives: To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture.

Methods: Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients.

Results: Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37).

Conclusion: Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Keywords: Fracture; Fracture incidence; Fracture risk; Osteoporosis; Rheumatoid arthritis.

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Conflict of interest statement

Declaration of competing interest Dr. Gomez-Vaquero has received fees for lectures and/or advice from Amgen, BMS, Eli Lilly, Gedeon-Richter, Grünenthal, MSD, Novartis, Roche, Stada and UCB. Dr. Hernandez received grant funding and fees for lectures from Amgen and MSD. Dr. Olmos has received past fees for lectures from Amgen, Eli Lilly, Stada and Gedeon-Richter. Dr. Naranjo has received past fees for lectures and/or advice from Amgen and UCB. Dr. Castañeda has received fees for lectures and/or advice from Amgen, BMS, Eli- Lilly, Gedeon-Richter, Grünenthal, MSD, Novartis, Pfizer, Roche, Sanofi, Stada and UCB. Dr. Garcia-Vadillo has received past fees for lectures from Amgen, Eli Lilly, UCB, Stada and Gedeon-Richter. Dr. Aguado Acin has received fees for lectures and/or advice from Abbie, Alexion, Amgen, Astra Zeneca, Eli Lilly, Faes, Gedeon-Richter, GP Pharm, Kyowa Kirin, MSD, Rubió and Theramex. Dr. Castellanos-Moreira has received past fees for lectures and/or advice from Pfizer, Lilly, UCB and BMS. Dr. Tebe has received fees for lectures from Amgen, Boehringer Ingelheim, and Gedeon Richter. Dr. Guañabens has received past fees for lectures and/or advice from Alexion, Amgen, Eli Lilly and UCB. The remaining authors have no competing interests to disclose.

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