Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Systematic Review Article

Is Rheumatoid Arthritis a Risk Factor for Fractures: A Systematic Review of Observational Studies

Author(s): Ambika Gupta*, Stephanie G. Pipe, Tanveer Towheed and Tassos Anastassiades

Volume 16, Issue 1, 2020

Page: [29 - 37] Pages: 9

DOI: 10.2174/1573397115666190723160312

Price: $65

Abstract

Aim: The primary objective was to assess the risk of fractures in adults with RA compared with controls from the general population. The review also assessed an increased risk of fractures in RA patients when accounting for steroid use, RA disease severity or functional impairment.

Methods: Citations were screened from MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and CINAHL. Included citations were written in English, including adult patients at least 18 years of age and compared fracture incidence or prevalence between RA patients and a control group. Case-control, cohort and cross-sectional studies were included.

Results: There were a total of 3451 citations; after application of the inclusion criteria, 17 studies were selected. In 14 of the 17 studies, there was an increase in the risk of fracture in RA patients compared to controls. In studies that evaluated for glucocorticoid use, four of 13 demonstrated an increased risk of fracture with glucocorticoid use, however, only two of these four studies specifically assessed glucocorticoid use amongst patients with RA. In studies that analyzed RA severity or functional impairment, two of seven demonstrated disease severity or impairment as a risk factor for fracture. There was marked study heterogeneity in terms of patient and fracture characteristics, which was a limitation of the analysis that impeded the ability to make direct comparisons.

Conclusion: The risk of fracture in RA patients is elevated when compared to the general population, although the etiology of the increased risk remains to be elucidated.

Keywords: Rheumatoid arthritis, glucocorticoids, risk of fracture, general population, patients, osteoporosis.

[1]
El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I. Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology (Oxford) 2010; 49(7): 1303-10.
[http://dx.doi.org/10.1093/rheumatology/keq084] [PMID: 20360038]
[2]
Ørstavik RE, Haugeberg G, Mowinckel P, et al. Vertebral deformities in rheumatoid arthritis: A comparison with population-based controls. Arch Intern Med 2004; 164(4): 420-5.
[http://dx.doi.org/10.1001/archinte.164.4.420] [PMID: 14980993]
[3]
Broy SB, Tanner SB, Members FPDC. Official Positions for FRAX® clinical regarding rheumatoid arthritis from joint official positions development conference of the international society for clinical densitometry and international osteoporosis foundation on FRAX®. J Clin Densitom 2011; 14(3): 184-9.
[http://dx.doi.org/10.1016/j.jocd.2011.05.012] [PMID: 21810523]
[4]
Avouac J, Koumakis E, Toth E, et al. Increased risk of osteoporosis and fracture in women with systemic sclerosis: A comparative study with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64(12): 1871-8.
[http://dx.doi.org/10.1002/acr.21761] [PMID: 22730393]
[5]
Filho JC, Pinheiro MM, de Moura Castro CH, Szejnfeld VL. Prevalence and risk factors associated with low-impact fractures in men with rheumatoid arthritis. Clin Rheumatol 2014; 33(10): 1389-95.
[http://dx.doi.org/10.1007/s10067-013-2426-9] [PMID: 24232459]
[6]
Peel NF, Moore DJ, Barrington NA, Bax DE, Eastell R. Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis 1995; 54(10): 801-6.
[http://dx.doi.org/10.1136/ard.54.10.801] [PMID: 7492217]
[7]
Kim SY, Schneeweiss S, Liu J, et al. Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 2010; 12(4): R154.
[http://dx.doi.org/10.1186/ar3107] [PMID: 20682035]
[8]
Başkan BM, Sivas F, Alemdaroğlu E, Duran S, Ozoran K. Association of bone mineral density and vertebral deformity in patients with rheumatoid arthritis. Rheumatol Int 2007; 27(6): 579-84.
[http://dx.doi.org/10.1007/s00296-007-0323-8] [PMID: 17287933]
[9]
Jalava T, Sarna S, Pylkkänen L, et al. Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 2003; 18(7): 1254-60.
[http://dx.doi.org/10.1359/jbmr.2003.18.7.1254] [PMID: 12854835]
[10]
Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses Ottawa: Ottawa Hospital Research Institute 2014. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
[11]
Amin S, Gabriel SE, Achenbach SJ, Atkinson EJ, Melton LJ III. Are young women and men with rheumatoid arthritis at risk for fragility fractures? A population-based study. J Rheumatol 2013; 40(10): 1669-76.
[http://dx.doi.org/10.3899/jrheum.121493] [PMID: 23950189]
[12]
Arai K, Hanyu T, Sugitani H, et al. Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: A cross-sectional and longitudinal study. J Bone Miner Metab 2006; 24(2): 118-24.
[http://dx.doi.org/10.1007/s00774-005-0657-9] [PMID: 16502118]
[13]
Brennan SL, Toomey L, Kotowicz MA, Henry MJ, Griffiths H, Pasco JA. Rheumatoid arthritis and incident fracture in women: A case-control study. BMC Musculoskelet Disord 2014; 15: 13.
[http://dx.doi.org/10.1186/1471-2474-15-13] [PMID: 24405804]
[14]
Cooper C, Coupland C, Mitchell M. Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis 1995; 54(1): 49-52.
[http://dx.doi.org/10.1136/ard.54.1.49] [PMID: 7880122]
[15]
Ghazi M, Kolta S, Briot K, Fechtenbaum J, Paternotte S, Roux C. Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int 2012; 23(2): 581-7.
[http://dx.doi.org/10.1007/s00198-011-1584-3] [PMID: 21350894]
[16]
Ørstavik RE, Haugeberg G, Uhlig T, et al. Self reported non-vertebral fractures in rheumatoid arthritis and population based controls: Incidence and relationship with bone mineral density and clinical variables. Ann Rheum Dis 2004; 63(2): 177-82.
[http://dx.doi.org/10.1136/ard.2003.005850] [PMID: 14722207]
[17]
Spector TD, Hall GM, McCloskey EV, Kanis JA. Risk of vertebral fracture in women with rheumatoid arthritis. BMJ 1993; 306(6877): 558.
[http://dx.doi.org/10.1136/bmj.306.6877.558] [PMID: 8461772]
[18]
van Staa TP, Geusens P, Bijlsma JW, Leufkens HG, Cooper C. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006; 54(10): 3104-12.
[http://dx.doi.org/10.1002/art.22117] [PMID: 17009229]
[19]
Wright NC, Lisse JR, Walitt BT, Eaton CB, Chen Z. Women’s Health Initiative InvestigatorsArthritis increases the risk for fractures--results from the Women’s Health Initiative. J Rheumatol 2011; 38(8): 1680-8.
[http://dx.doi.org/10.3899/jrheum.101196] [PMID: 21572148]
[20]
Lin YC, Li YH, Chang CH, et al. Rheumatoid arthritis patients with hip fracture: a nationwide study. Osteoporos Int 2015; 26(2): 811-7.
[http://dx.doi.org/10.1007/s00198-014-2968-y] [PMID: 25410437]
[21]
Huusko TM, Korpela M, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland. Ann Rheum Dis 2001; 60(5): 521-2.
[http://dx.doi.org/10.1136/ard.60.5.521] [PMID: 11302878]
[22]
Chen B, Cheng G, Wang H, Feng Y. Increased risk of vertebral fracture in patients with rheumatoid arthritis: A meta-analysis. Medicine (Baltimore) 2016; 95(45)e5262
[http://dx.doi.org/10.1097/MD.0000000000005262] [PMID: 27828847]
[23]
Hooyman JR, Melton LJ III, Nelson AM, O’Fallon WM, Riggs BL. Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum 1984; 27(12): 1353-61.
[http://dx.doi.org/10.1002/art.1780271205] [PMID: 6508860]
[24]
Leib ES, Saag KG, Adachi JD, et al. FRAX(®) Position Development Conference Members. Official Positions for FRAX(®) clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX(®) of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX. J Clin Densitom 2011; 14(3): 212-9.
[http://dx.doi.org/10.1016/j.jocd.2011.05.014] [PMID: 21810527]
[25]
Kirwan JR. The Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med 1995; 333(3): 142-6.
[http://dx.doi.org/10.1056/NEJM199507203330302] [PMID: 7791815]
[26]
Nampei A, Hashimoto J, Koyanagi J, et al. Characteristics of fracture and related factors in patients with rheumatoid arthritis. Mod Rheumatol 2008; 18(2): 170-6.
[http://dx.doi.org/10.3109/s10165-008-0032-5] [PMID: 18297237]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy