Rheumatoid Arthritis Patients Face Higher Fracture Risk apart from BMD Levels, suggests study

Rheumatoid arthritis is a chronic inflammatory disorder and not only causes damage to joints but is also considered a risk factor for the development of fractures. Studies published in the recent past have shown conflicting results on the association of low bone mass and fracture risk in patients with RA. The present study was undertaken to determine the fracture risk in newly diagnosed RA patients in comparison with controls and to recognize predictors for fractures.

The cohort consisted of 232 newly diagnosed RA patients, matched by age and sex, against 931 controls. Patients were recruited from Malmö University Hospital in Sweden between the years 1995 and 2005. Repeated clinical assessments and BMD measurements were collected during 10 years. Fractures were identified using ICD codes, and Cox regression models adjusted fracture risk and predictors.

The key findings of the study were as follows:

Demographics:

• RA Group: 163 women and 69 men, mean age 60.5 years, 70.3% female.

• Control Group: 70.5% female, mean age 60.5 years.

• Mean symptom duration at baseline: 7.4 months.

Fracture Risk:

• Patients with RA had a significantly higher risk of fractures (fully adjusted hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.13; 2.06).

• Mean time to first fracture: 9.6 years (RA group) vs. 10.0 years (control group).

Predictors of Fractures:

• Higher age: HR per standard deviation (SD) 2.20, 95% CI 1.64; 2.94.

• Low body mass index (BMI): Sex- and age-adjusted HR per SD 0.58, 95% CI 0.44; 0.77.

• Low BMD at baseline.

• Worse Health Assessment Questionnaire (HAQ) scores: Age-sex-adjusted HR 1.33 per SD, 95% CI 1.09; 1.63.

• Inverse association between BMD Z-scores over time and fractures.

The study demonstrated that RA patients have an increased risk of fractures compared to controls, despite their BMD levels. The findings suggest that additional factors, such as falls, muscle weakness, poor balance, and impaired bone quality, contribute to the higher fracture risk in RA patients.The study concluded that predicting and preventing fractures in RA is quite complex and needs a multi-faceted approach. For successful prevention of fractures in the course of RA, optimal treatment of arthritis, anti-osteoporosis therapy, and assessment of the risk of falls are important. Further research is needed to identify early detectable risk factors for fractures in patients with RA.

Reference:

Theander L, Sharma A, Karlsson MK, Åkesson KE, Jacobsson LTH, Turesson C. Risk and predictors of fractures in early rheumatoid arthritis - A long term follow up study of an inception cohort. Semin Arthritis Rheum. Published online June 27, 2024. doi:10.1016/j.semarthrit.2024.152497