Original Article

Characteristics of fracture and related factors in patients with rheumatoid arthritis

Authors

Akihide Nampei¹, Jun Hashimoto¹, Junichiro Koyanagi¹, Takeshi Ono¹, Hideo Hashimoto¹, Noriyuki Tsumaki¹, Tetsuya Tomita¹, Kazuomi Sugamoto¹, Norihiro Nishimoto², Takahiro Ochi³ and Hideki Yoshikawa¹

1. Department of Orthopaedics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
2. Laboratory of Immune Regulation, Osaka University Graduate School of Frontier Bioscience, 1-3 Yamadaoka, Suita 565-0871, Japan
3. Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku Osaka, 543-0035, Japan

Received:

14 September 2007

Accepted:

14 November 2007

Published online:

23 February 2008

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Abstract

To examine the clinical features of vertebral and non-vertebral fractures in patients with rheumatoid arthritis (RA), including insufficiency fractures, and to assess the risk factors for fracture, we prospectively studied 209 outpatients with rheumatoid arthritis for 1 year. The age, gender, Steinbrocker’s functional class, glucocorticoid use, history of lower limb surgery, serum C-reactive protein (CRP), and use of bisphosphonates were evaluated. Examination for fractures was performed by radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scanning. Thirty-three fractures occurred in 24 patients over the 1-year study period, and the incidence was 15.8 fractures per 100 patient-years. Fractures occurred at various sites. The majority (70%) was insufficiency fracture, and more than 50% caused ambulatory dysfunction. Radiographic findings were absent in 39% of the fractures at the onset of pain. The functional class and glucocorticoid dose were significantly associated with fracture development. This prospective study showed that the incidence of fractures, especially insufficiency fractures, was very high in patients with rheumatoid arthritis and that most of their fractures caused gait disturbance. Early intervention to prevent secondary osteoporosis is recommended to maintain the quality of life in patients with rheumatoid arthritis, especially those with functional impairment or undergoing glucocorticoid therapy.

Key words

Fracture - Incidence - Insufficiency fracture - Rheumatoid arthritis - Risk factor